Laparoscopic Versus Open High Ligation for Adolescent Varicocele: A 6-year Single Center Study

ABSTRACT

Objective: The aim of this study was to compare the outcomes of high ligation in adolescentswith varicocele between open and laparoscopic surgical approaches. Design: Retrospectivestudy. Setting: The study was conducted from January 2012 to January 2018, with medianfollow-up of 36 months, in the division of pediatric surgery at tertiary-care hospital. PatientsData of 537 adolescents who underwent varicocelectomy were classified into two groups,depending on surgical approach. Intervention Open or laparoscopic varicocelectomy. Mainoutcome measures: Indications for surgery, complications, duration of surgery, hospitalstay, and recurrences rate. Results: The median age of the patients was 15 years. Themedian (IQR) duration of surgery was 12 (11,15.3) min in laparoscopic and 25 (10,30) min inopen group (P<0.001). The most common complication was hydrocele (n=29), which wasmore common in open group (6.8% vs 1.4%; P=0.01). A total of 16 recurrences wererecorded, all in open group (P=0.049). In both groups, sperm concentration (P<0.001),morphology (P<0.001) and motility (laparoscopy, P=0.001; P=0.02; open varicocelectomy,P=0.001; P=0.04) improved six months after surgery in patients with varicocele stage I and II.In stage III there was an improvement in sperm concentration (P=0.002; P=0.001) andmorphology (P=0.03; P=0.06), while sperm motility (P=0.15; P=0.2) did not significantlyrecover in either of the groups. Conclusions: Laparoscopic and open varicocelectomy areequally effective and result in significant improvement of testicular volume, disappearance ofpain, and sperm parameters in adolescents. Based on our findings laparoscopicvaricocelectomy is associated with shorter operating time, shorter hospitalization, fasterrecovery, and fewer complications and recurrences