The efficacy of laparoscopic selective ligation of spermatic vein for the treatment of varicocele : a meta-analysis

Abstract

Objectives To evaluate clinical efficacy of laparoscopic selective ligation of spermatic vein,including laparoscopic high ligation of internal spermatic vein,laparoscopic varix ligation with internal spermatic artery preservation and laparoscopic varix ligation with lymphatic vessels,and laparoscopic cluster ligation of spermatic vessels for the treatment of varicocele.Methods Such database as cochrane central register of controlled trials (CENTRAL),PubMed,EMbase,CNKI,VIPand Wangfang were searched from their establishment to December 2012 for collecting the randomized controlled trials (RCT) about laparoscopic selective ligation of spermatic vein and laparoscopic cluster ligation of spermatic vessels for the treatment of varicocele.and the references of those RCTs were also searched by hand.After study selection,assessment and data extraction conducted by two reviewers independently,meta-analyses were performed by using the RevMan 5.1 soft ware.The level of evidence was assessed by using the GRADE system.Results 13 studies involving 1061 patients were included.The results of meta-analyses showed that:①compared with the control group,laparoscopic selective ligation of spermatic vein had lower incidence of postoperative secondary hydrocele [RR =0.07,95 ％ CI (0.03,0.19)],postoperative testicular atrophy [RR =0.09,95％ CI(0.03,0.27)],and higher rate of semen quality improvement [RR =1.29,95 ％ CI (1.08,1.55)] and spontaneous pregnancy [RR =1.53,95％ CI (1.03,2.29)],but longer operation time [SMD =1.83,95％ CI (0.37,3.28)],higher recurrence rate [RR =3.73,95 ％ CI (1.92,7.23)].②compared with the control group,laparoscopic high ligation of intemal spermatic vein had lower incidence of postoperative secondary hydrocele [RR =0.04,95％ CI (0.01,0.21)],postoperative testicular atrophy[RR =0.08,95％ CI (0.02,0.3)],and higher rate of semen quality improvement [RR =1.37,95 ％ CI (1.12,1.68)] and spontaneous pregnancy [(RR =1.76,95 ％CI (1.00,3.07)],but longer operation time [SMD =3.16,95 ％ CI (2.15,4.16)],higher recurrence rate [(RR =3.85,95％ CI(1.62,9.17)].③compared with the control group,laparoscopic varix ligation with internal spermatic artery preservation had lower incidence of postoperative testicular atrophy [(R R =0.12,95 ％ C I (0.02,0.86,P =0.04)] and higher recurrence rate [(RR =5.68,95％ C I (1.50,21.53)],P =0.01).But there were no significant in postoperative secondary hydrocele incidence and semen quality improvement rate(P ＞ 0.05).④compared with the control group,laparoscopic varix ligation with lymphatic vessels had lower incidence of postoperative secondary hydrocele[RR =0.10,95％ CI(0.02,0.52,P =0.007)] and longer operation time[(SMD =0.52,95％ CI(0.17,0.87,P =0.004)].But there were no significant in recurrence rate and spontaneous pregnancy rate(P ＞ 0.05).Conclusions The current evidence shows:compared with the laparoscopic cluster ligation of spermatic vessels,laparoscopic selective ligation of spermatic vein,especially artery-lymphatics sparing laparoscopic varicocelectomy,had lower incidence of postoperative secondary hydrocele and postoperative testicular atrophy,and higher rate of semen quality improvement and spontaneous pregnancy,but longer operation time and higher recurrence rate.The long -term efficacy remains high-quality and large-sample studies are required. Key words: Varicocele; Laparoscopy; Ligation; Meta-Analysis