Varicocele - laparoscopic versus open ligation

Abstract

Objective: Evaluation of the advantages and disadvantages of laparoscopic varicocelectomy and its comparison with open ligation of varicocele. Design: Prospective comparative study between two techniques of varicocelectomy. Place and Duration Of Study: Surgical unit III of Jinnah Hospital, Allama Iqbal medical college, Lahore over a period of two years from January 1, 2002 through December 31, 2003. Subjects and Methods: Study comprised of two groups (A and B) with 52 consective patients fulfilling the inclusion criteria and comparative variables. Laparoscopic varicocelectomy (LPV) was performed on 26 patients (Group A) and open Palomo varicocelectomy (OPV) was performed on 26 patients (Group B). Outcome data looked at relapse rate, postoperative hydroceles, wound complication and scrotal edema. Operating time, postoperative hospital stay and pain control were compared. In both groups operation was performed by Palomo technique i.e. ligation of both artery and internal spermatic vein in the retro peritoneum above the internal inguinal ring. Results: In LPV versus OPV group, the recurrence rate of varicocele was 3.8% in-group A versus no recurrence in-group B (p<0.001). Postoperative hydroceles formation was 7.6% in group A versus 11.4% in group B (p < 0.003 ).wound complication was 3.8% in group A versus 7.6% in group B (p < 0.001). Testicular or scrotal edema was 7.6% in group A versus 11.4% in group B.Postoperative hospital stay was 24 hours in group A versus 72 hours in group B (p < 0.001). Operating time was 20 minutes in group A versus 30 minutes in group B (p <0.001). Postoperative analgesia required was almost half in group A as compared to group B (p < 0.005). Conclusion: The study shows that clinical efficacy of laparoscopic varicocelectomy is superior to traditional open varicocelectomy.