External spermatic vein ligation improves the outcome of varicocele surgery: fact or fiction

Internal spermatic vein is the major route of testicular venous drainage However, Surgical failure after varicocelectomy is mostly due to persistent incompetent collaterals distal to the site of ligation of internal spermatic vein and the most important collaterals is the external spermatic vein. The aim of this study was to estimate the incidence of external spermatic vein in infertile patients and to evaluate the results of inguinal varicocelectomy with combined ligation of both internal and external spermatic veins. Eighty inguinal varicocelectomies were performed on 45 infertile patients with varicocele ranging in age from 20-40 years. There were 15 fertile control patients undergoing inguinal herniorrhaphy. There were 35 patients with bilateral varicocele and 10 patients with isolated left sided varicocele [Thirty-Seven patients with primary infertility and 8 patients with secondary infertility]. Grade 2 varicocele was the commonest one [52.5%]. External spermatic veins were detected in 57 varicocelectomies [71.25%]. Improvement in semen parameters was detected postoperatively. Pregnancy occurred in 14 cases [31%] on follow up period of one year after surgery. Subclinical recurrence of varicocele occurred in 3 patients [6.6%]. Vaginal hydrocele occurred in 2 patients [4.4%]. Among control group external spermatic vein was detected only in 2 patients [13.3%]. External spermatic vein is commonly found in patients with varicocele and its ligation during inguinal varicocelectomy improves the results of surgery. So, careful searching for this vein and its ligation is advised