Abstract
Background
This study aimed to assess whether laparoscopic treatment for any kind of varicocele is possible after preoperative identification of refluxing veins by color Doppler ultrasound (CDUS).
Methods
At the authors’ institution, 98 patients with a median age of 11.3 years (range, 7.1–16 years) were evaluated for a left varicocele. Preoperatively, all the patients underwent ultrasound scan assessment of testicular volume and CDUS to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. In all the patients, laparoscopic division of the spermatic artery and veins was performed as close as possible to the internal inguinal ring. The other vessels were coagulated and divided if shown to be refluxing on CDUS.
Results
Color Doppler ultrasound showed reflux only in the ISV in 87 cases (88.7%), but in both the ISV and the deferential in the remaining 11 cases (11.2%). During a median follow-up period of 18 months (range, 6–49 months), none of the authors’ patients experienced varicocele recurrence either clinically or according to CDUS scanning. The median left testicular volume increased significantly postoperatively.
Conclusion
The proposed technique based on laparoscopic interruption of the ISV and testicular artery very close to the internal inguinal ring, meticulous CDUS assessment to rule out reflux in the deferential vein, and coagulation of refluxing deferential veins allows successful laparoscopic treatment of most varicoceles.
Similar content being viewed by others
References
Coolsaet BL (1980) The varicocele syndrome: venography determining the optimal level for surgical management. J Urol 124:833–839
Skoog SJ, Roberts KP, Goldstein M, Pryor JL (1996) The adolescent varicocele: what’s new with an old problem in young patients? Pediatrics 100:112–122
Diamond DA (2003) Adolescent varicocele: emerging understanding. BJU Int 92:48–51
Niedzielski J, Paduch DA (2001) Recurrence of varicocele after high retroperitoneal repair: implications of intraoperative venography. J Urol 165:927–929
Campobasso P (1997) Blue venography in adolescent varicocelectomy: a modified surgical approach. J Pediatr Surg 32:1298–1301
Cimador M, Castagnetti M, Ajovalasit V, Libri M, Bertozzi M, De Grazia E (2003) Subinguinal interruption of dilated veins in adolescent varicocele: should it be considered a gold standard technique? Minerva Pediatr 55:599–605
Cimador M, Di Pace MR, Peritore M, Sergio M, Castagnetti M, De Grazia E (2006) The role of color Doppler ultrasound in determining the proper surgical approach to the management of varicocele in children and adolescents. BJU Int 97:1291–1297
Dubin L, Amelar RD (1970) Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril 21:606–609
Lenz M, Hof N, Kersting-Sommerhoff B, Bautz W (1996) Anatomic variants of the spermatic vein: importance for percutaneous sclerotherapy of idiopatic varicocele. Radiology 198:425–431
Kass EJ, Marcol B (1992) Results of varicocele surgery in adolescents: a comparison of techniques. J Urol 148:694–697
Franco G, Iori F, de Dominicis C, Dal Forno S, Mander A, Laurenti C (1999) Challenging the role of cremasteric reflux in the pathogenesis of varicocele using a new venographic approach. J Urol 161:117–121
Nyirady P, Kiss A, Pirot L, Sarkozy S, Bognar Z, Csontai A, Merksz M (2002) Evaluation of 100 laparoscopic varicocele operations with preservation of testicular artery and ligation of collateral vein in children and adolescent. Eur Urol 42:594–597
Niedzielski J, Paduch D, Raczynsji P (1997) Assessment of adolescent varicocele. Pediatr Surg Int 12:410–413
Nagar H, Mabjeesh NJ (2000) Decision making in pediatric varicocele surgery: use of color Doppler ultrasound. Pediatr Surg Int 15:75–76
Esposito C, Monguzzi GL, Gonzales-Sabin MA, Rubino R, Montinaro L, Papparella A, Amici G (2000) Laparoscopic treatment of pediatric varicocele: a multicenter study of the Italian society of video surgery in infancy. J Urol 163:1944–1946
Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C (1992) Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic-sparing technique. J Urol 148: 1808–1811
Dudai M, Sayfan J, Mesholam J, Sperber Y (1995) Laparoscopic simultaneous ligation of internal and external spermatic veins for varicocele. J Urol 153:704–705
Esposito C, Valla JS, Najmaldin A, Shier F, Mattioli G, Savanelli A, Castagnetti M, McKinley G, Stayaert H, Settimi A, Jasonni V, Guys JM (2004) Incidence and management of hydrocele following varicocele surgery in children. J Urol 171:1271–1273
Oswald J, Korner I, Riccabona M (2001) The use of isosulphan blue to identify lymphatic vessels in high retroperitoneal ligation of adolescent varicocele: avoiding postoperative hydrocele. BJU Int 87:502–504
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cimador, M., Di Pace, M.R., Castagnetti, M. et al. Comprehensive laparoscopic approach to pediatric varicocele based on preoperative color Doppler ultrasound assessment. Surg Endosc 22, 701–705 (2008). https://doi.org/10.1007/s00464-007-9464-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9464-9