Outcome of Lymphatic- and Artery-Sparing Surgery for Pediatric Varicocoele

Abstract

In recent years, laparoscopic equipment, and experience with its use, has improved. We are now able to appreciate microanatomy, and dissection of individual lymphatic channels is possible. Previously, the results of laparoscopic lymphatic-sparing procedures has been reported. In this study, we report our experience of the preservation of both the lymphatic channels and the testicular artery during laparoscopic varicocelectomy and its outcomes. All boys undergoing laparoscopic varicocelectomy between June 2004 and February 2009 were included in the study. The demographic details, operative findings, complications, and length of stay were recorded on a Microsoft Excel spreadsheet and complications at follow-up noted. The operation was performed via a transperitoneal approach, and the retroperitoneum was entered proximal to the internal ring by peritoneal division over the vessels. The spermatic vein or veins were isolated and stripped of the surrounding lymphatics and artery and secured with ligaclips. Any other tortuous veins around the internal ring were also ligated at the time of operation. Nineteen boys underwent laparoscopic varicolectomy. Complications were 1 intraoperative small bowel injury, 1 hydrocele (5%), and 4 persistent varices (21%), one of which was symptomatic, requiring a low ligation of spermatic veins through a groin approach. This study shows good results with regard to postoperative hydrocoele rates. The preservation of the lymphatic supply ensures adequate lymphatic drainage, therefore, minimizing the risk of developing a hydrocele postoperatively. The risk of persistent varices, compared to the traditional en-masse technique, is a source of concern and requires further study.