Successful outcomes in adolescent varicocele treatment with high-level laparoscopic varicocelectomy
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In brief
In brief
Retrospective study of 47 adolescent patients comparing high-level versus low-level testicular vein ligation during laparoscopic varicocelectomy. High-level ligation cranial to the linea terminalis demonstrated lower complication rates with minimal hydrocele formation and recurrence, suggesting superior outcomes for this surgical approach.
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Purpose
In this study, we aimed to compare the effects of testicular vein ligation level on complications encountered; i.e. high-level ligation cranial to the linea terminalis vs ligation caudal to the linea terminalis.
Methods
A total of 47 unilateral adolescent patients, treated with laparoscopic varicocelectomy between January 2004 and December 2017, were reviewed retrospectively. Patients were divided into two groups in terms of ligation level: caudal to the linea terminalis as group 1 and cranial to the linea terminalis as group 2. Symptoms, varicocele grades, preoperative testicular growth arrest, operative method, hydrocele formation, postoperative recurrence and testicular catch-up growth were recorded.
Results
The mean operation time was 38.6 ± 10.2 min (34–53 min) in group 1 and was 33.6 ± 6.4 min (29–42 min) in group 2. Single hydrocele occurred in the laparoscopic nonselective varicocelectomy in group 1 (4.5%) and was successfully treated with open hydrocelectomy. Single varicocele recurrence was observed in the laparoscopic selective varicocelectomy in group 1 (4.5%) and treated with laparoscopic nonselective varicocelectomy cranial to the linea terminalis.
Conclusions
The high-level ligation of the spermatic veins cranial to the linea terminalis during laparoscopic varicocelectomy, independent of the technique applied, may contribute to reasonable low hydrocele and recurrence rates.
Level of evidence
Level III.