Evaluation of 100 laparoscopic varicocele operations with preservation of testicular artery and ligation of collateral vein in children and adolescents.

Abstract

To introduce a useful technique for identifying any collateral veins during laparoscopic varicocele operation and to evaluate our long-term results with this technique after 100 cases. A new method was used to detect an incidental collateral vein. During surgery the patient was placed in anti-Trendelenburg position after introducing laparoscopic instruments until the dilated scrotal varicose filled up with blood. The main spermatic vein was then grasped atraumatically and the blood was pressed out manually from the scrotum. During this manoeuvre any existing collateral vein/veins became dilated and could be easily identified. The dilated spermatic vein and also any collateral vessel were first prepared then clipped. Out of the 100 patients, collateral veins were detected and ligated in 19 cases. In 15 cases a single collateral, in 4 cases two collaterals, and in the remaining 81 children no collateral veins were found. The testicular artery was identified in all operations as a pulsatile vessel. At a mean of 24 months (range 6-60 months) follow-up recurrence occurred in one patient and in five children hydrocele developed postoperatively. Testicular atrophy and severe intra- or postoperative complication did not occur in any patient of this series. The identification of incidental collateral vein by this method and preservation of the testicular artery resulted in a very good success rate in children and adolescents treated by laparoscopic varicocele operation.