Postsurgical Outcomes Assessment Following Varicocele Ligation: Laparoscopic Versus Subinguinal Approach

Abstract

Objectives. To prospectively compare and objectively assess the postsurgical outcome parameters of both laparoscopic and open subinguinal techniques for varicocele ligation in infertile men. Methods. A total of 41 evaluable patients with a history of infertility, abnormal semen analysis, and clinically diagnosed varicoceles underwent surgical ligation either by the insufflative intraperitoneal laparoscopic (n = 15), gasless laparoscopic (n = 7), or the open subinguinal (n = 19) approach. Most procedures (39 of 41) were performed in the outpatient setting, and patients were followed postoperatively for a minimum of 6 months. Postsurgical outcome was assessed by physical examination and review of a patient questionnaire quantifying the graded pain severity, analgesic requirements, and number of days to return to work. Results. The average operative time was 82.3 ± 26.5 minutes for insufflative intraperitoneal laparoscopic varicocelectomy, 170 ± 55 minutes for gasless laparoscopic varicocelectomy, and 35.6 ± 13.5 minutes for the open subinguinal approach. The analgesic requirement was 13.7 ± 9.9 tablets for the insufflative laparoscopic group, 22.5 ± 11 tablets for the gasless laparoscopic group, and 10.9 ± 10.3 tablets for the open subinguinal group. The average number of days to return to work was 4.9 ± 2.7 for the insufflative group, 6.6 ± 2.6 for the gasless group, and 5.1 ± 3.7 for the open subinguinal group. Conclusions. These results show no superiority of laparoscopic techniques over the standard open subinguinal technique with respect to hospital stay, analgesic requirements, or return to work. Laparoscopic techniques require excessive operative time, may have attendant complications, and require general anesthesia, limitations that preclude their routine application in varicocele ligation. However, the laparoscopic approach may have a role in the setting of other concurrently performed laparoscopic procedures.