Laparoscopic Varicocelectomy Using Polymeric Ligating Clips and Its Effect on Semen Parameters in Pediatric Population with Symptomatic Varicocele: A 5-Year Single Surgeon Experience.

Abstract

The aim of this study was to evaluate demographic and clinical characteristics of the children undergoing laparoscopic varicocelectomy by using polymeric ligating clips and to evaluate postoperative outcomes and analyze semen according to the grade of varicocele after surgery. The case records of 120 pediatric patients who underwent laparoscopic varicocelectomy were retrospectively reviewed. The following parameters were examined: age, grade of varicocele, lateralization, diameter of spermatic veins, indications for surgery, duration and outcomes of surgery, complications, and recurrence rate. For patients older than 16 years of age, semen analyses were obtained before and after the surgery and were compared according to the clinical grade of varicocele. The median age of the patients was 15 years. Of the total number of patients, left-sided varicocele was found in 119 patients and bilateral varicocele was found in 1 patient. Of the 120 varicoceles, 8 (6.7%) were grade I, 58 (48.3%) were grade II, and 54 (45%) were grade III. There were no major intraoperative complications. Hydrocele was found in 2 (1.6%) patients. There were no cases of recurrence recorded. Sperm concentration (P < .01), morphology (P < .01), and motility (P < .01; P = .02) improved 6 months after surgery in patients with varicocele grades of I and II, respectively. In grade III varicocele, only sperm concentration (P < .01) and morphology (P = .03) improved whereas motility (P = .150) did not change significantly. Laparoscopic varicocelectomy using polymeric ligating clips is a safe, feasible, and cost-effective technique, with a low rate of postoperative complications and recurrence and it significantly improves sperm parameters in adolescents.