ABSTRACT
Objectives: To compare the outcome of laparoscopic versus open varicocelectomy in sub-fertile obese men presenting with bilateral testicular varicoceles. Materials and Methods Forty obese (body mass index 30) primary sub-fertile males with bilateral varicoceles have been selected for this study and randomized to either laparoscopic varicocelectomy (Goup I; n=20) patients or high retroperitoneal open ligation (Group II; n=20) patients. Semen analysis was performed preoperatively and three months or more postoperatively. Scrotal duplex was done for each case preoperatively and 6 months post-operatively. Results The average operative time in Group I and Group II was ~77.3 minutes and ~58 minutes; respectively (P 0.05). Analgesia requirements were significantly less in the laparoscopic group. Only one patient of Group I developed subcutaneous haematoma; while in Group II three developed wound infections and six patients developed wound seroma. The average hospital stay of the patients of Groups I and II was 8.4 hours and 52 hours; respectively (P 0.05). The patients of Group II returned to their usual daily activities after an average of 5.3 days; while the patients of Group II needed an average of 8.4 days (P 0.05). Hydrocele occurred in none of the patients of Group I and in 3 patients (15.7) of Group II (P0.05). Recurrence of the varicocele occurred in none of the patients of Group I; but in 3 patients (15.7) of Group II (P 0.05). The semen parameters improved after surgery in both groups. The mean improvement in sperm concentration was ~ 32.5 million sperm/ml in Group I and ~25 million sperm/ml in Group II (p0.05). The mean improvement in total sperm count was ~ 96 million sperms in Group I and ~92 million sperms in Group II (p0.05). The mean percentage of improvement in sperm motility was ~ 16.5in Group I and 14.1in Group II (p 0.05). The mean decrease in the percentage of abnormal forms was ~20in Group I and ~5.5in Group II (p 0.05). Moreover; the quality of motility (grades) improved significantly after laparoscopic varix ligation; to a higher extent than after open surgery. Conclusion: The laparoscopic approach is an excellent option for varix ligation in obese patients. Morbidity is less and convalescence is shorter compared to open surgery. A particular advantage of laparoscopy over conventional surgery is the possibility of treatment of bilateral varicoceles through the usual three laparoscopic ports. In this study improvement in some semen parameters was significantly better following laparoscopic varix ligation. This may be explained by the better view and magnification offered by laparoscopy