Lymphatic and testicular artery-sparing laparoscopic varicocelectomy in children and adolescents

الملخص EN

Background / aim The ideal operation for the treatment of adolescent varicocele has been debated for many years.

The division of lymphatic vessels during varicocelectomy is complicated by hydrocele formation and decline in testicular function.

The aim of this study is to report on our series of children who underwent lymphatic and testicular artery-sparing laparoscopic varicocelectomy (LTASLV).

Patients and methods Thirty boys with primary left-sided varicocele were subjected to LTASLV.

The indications for intervention were scrotal pain and discomfort in 18 cases (60 %), hypotrophy in nine cases (30 %), and family preference in three cases (10 %).

An intraparenchymal injection of 2 ml methylene blue was administered after induction of anesthesia.

LTASLV was performed for all patients.

The main outcome measurements included operative time, hospital stay, development of hydrocele, varicocele recurrence, and testicular atrophy.

Results The study included 30 patients with primary left-sided varicocele.

Their mean age was 12.25 ± 1.6 years (range 9–16 years).

Grade 3 varicocele was present in 21 cases (70 %) and grade 2 varicocele was present in nine cases (30 %).

Stained lymphatics could easily be observed alongside the testicular artery and veins in 28 cases, whereas in two cases, a second injection of methylene blue with lowering of CO2 pressure was required for visualization.

All procedures were completed laparoscopically without conversions or complications.

The mean operative time was 40 ± 2.6 min (range 30–50 min).

All patients achieved full recovery and were discharged within 24 h.

The mean follow-up period was 18 ± 4.3 months (range 10–36 months).

Residual varicocele was noted in one case (3.3 %) with no hydrocele formation or testicular atrophy.

Conclusion This study shows good results with respect to postoperative hydrocele rates.

LTASLV resulted in 0 % of hydrocele and decreased the risk of varicocele recurrence.

However, larger series are necessary.