Conception Outcome of Laparoscopic Versus Open Varicocelectomies with Their Advantages and Disadvantages: Laparoscopic Varicocelectomy results in comparison to open Varicocelectomy

Abstract

Objective: As the laparoscopic varicocelectomy was newly invented in this field, various studies are required to evaluate and compare between old opened method and this new developed method from various views mainly the output results and some observed postoperative complications of both methods, then to decide preferable method. Cases and methods: This study under run in period of 11/2/2018 to end of January/ 2019, during which (60) cases randomly collected. All selected cases were complained of infertility, claimed to be due testicular Varicocele. Of these; (32) cases were laparoscopically managed and the other (28) cases managed by open method. The inclusive criteria were concentrated on male infertile cases in which the parameters were below normal values due to 2010- WHO guidelines of Basal sperm analysis (BSA). The main causes supposed to be due to varicocele consequences clinically and proved by Doppler ultrasonic studies. While the varicocelectomy operations for other indications were excluded from study. Both operations performed in Arbil-Iraq city hospitals; then follow up carried on two monthly intervals. SPSS version package 24 is used; presented data are used as Mean ± STD. (P-value < 0.05 regarded non-significant). Results: The included ages were (24 to 43) years and mean age was 33.5 years age. In nearly 33 cases only left testis affected while the remnant 9 cases were bilateral testes. Grades of varicocele were 28 Grade III, 25 GII and 7 cases of GI. Of these infertile men 36 cases were secondary infertile and 28 cases primary infertile. duration of infertility arranged between 2-6 years. Postoperative follow up showed an acute rising of motility and quality of sperms after 4-8 weeks period among laparoscopy cases and slide down again for a period of 12-20 weeks, then returned minimum normal level at the end of 24 weeks and (9) (28.18%) cases achieved conception in the first 6 months. In the opened group the changes were slow and remained for 24 weeks to achieve wanted normal parameters and accordingly only 10 (35.71%) cases achieved conception. Regarding postoperative complications were like all other studies in this regard; less complications and shorter recovery period no more than 72 hours were observed. The average duration of operation in laparoscopic method was 42±5 minutes in unilateral 60±8 minutes in bilateral cases while in open method 35±5 minutes in unilateral, and 50±5 minutes in bilateral cases. Conclusions: The laparoscopic varicocelectomy is promising method of treating varicocele for treating abnormal sperm parameters, by same ports sites were used, giving better views of visions for uni or bilateral cases especially in subclinical varicoceles, moreover to magnified visualization of main and collateral veins. Although mild significant conceiving advantage of open method over laparoscopic mode detected (P value > 0.06) but the laparoscopic varicocelectomy is less disabling, least traumatic, complicated in expert hands and more economic with nearly same comparative results purposed as the open method.