Laparoscopic Varicocelectomy by Artery Preserving and Mass Ligation Technique- A Comparative Study
DOI:
https://doi.org/10.14738/jbemi.96.13498Keywords:
Varicocele, Laparoscopic varicocelectomy, Artery preserving, Mass ligationAbstract
Background- There are multiple methods of varicocele treatment. No single approach is adopted as the best therapeutic option. Laparoscopic varicocelectomy (LV) is one of them. Artery sparing laparoscopic varicocelectomy was found to have high recurrence in literature. Retroperitoneal mass ligation of testicular vein and artery was first done in original Palomo operation. Chance of missing some veins are also less if mass ligation is done in LV. Testes get blood supply from testicular artery, cremasteric artery and artery to the vas. For this reason ligation of the testicular artery in the abdomen do not cause ischemia to testes. We present our experience on comparative study between LV with mass ligation (ML) and artery preserving (AP) technique. We compared the operation time, outcome, and complication in two groups of patients. Methods-Forty-eight varicoceles, both unilateral and bilateral, were operated over a period of three years. Twenty three underwent ligation of veins alone and twenty-five underwent ligation of testicular veins and artery en-mass. They were followed up for a period of three months after surgery. We collected all data in a prospective manner. Results: The average operation time for the artery-preserved and the mass ligated group was 41±5 minutes and 27±3 minutes respectively. Average post-operative hospital stay was 46±12 hrs. and 32±7 hours respectively. There were no technical failures in either group. Complications and recurrence were less in the mass-ligation than in the artery-preserved group. On an average follow-up of 3 months all patients remained asymptomatic and had complete reduction in the size of the varicoceles. There were no incidence of testicular atrophy in either group. Conclusion: Laparoscopic varicocelectomy with mass ligation technique is safe, effective, less time consuming and easy to perform. Recurrence and post-operative complications are minimum. This should preferably be done with mass ligation with an attempt to spare lymphatics.
References
Oster J: Varicocele in children and adolescents: An investigation of the incidence among Danish school children. Scand J Urol Nephrol; 1971; 5: 27-32.
Kass EJ: Adolescent varicocele: Current concepts. Semin Urol; 1988; 6: 140-145.
Saypol DC: Varicocele. J Androl; 1981; 2: 61-71.
Demas BE, Hricak H, McLure RD: Varicoceles: Radiologic diagnosis and treatment. Radiol Clin North Am 1991; 29: 619-627.
Ayechu-Díaz A, Oscoz-Lizarbe M, Pérez-Martínez A, Pisón-Chacón J, Bento L: Treatment of adolescent varicocele: is percutaneous embolization better? Cir Pediatr; 2009; 22(3): 134-8.
Franco I. Laparoscopic varicocelectomy in the adolescent male. Curr Urol Rep; 2004; 5(2): 132-6. 93
Al KandaryAM,Shaban H, Ibrahim HM, ElshayebiniYH,ShokeirAA:Comparison outcome of different varicocelectomy technique-open inguinal,laparoscopic and subinguinal microscopic varicocelectomy:a randomized clinical trial.Urology,2007 Mar,69(3):417-208.
Mc MnnusMC, Barqawi A, Meacham RB, Furness PD 3rd, Koyle MA:Laparoscopic varicocele ligation: are there advantages compared with the microscopic subinguinal approach? Urology. 2004 Aug,64(2):357-61.
Keys C, Barbour L, O'Toole S, Sabharwal A: Laparoscopic surgery for varicoceles in children: an audit in a single centre. J Laparoendosc Adv Surg Tech A; 2009;19 Suppl 1: S107-9.
Pini Prato A, MacKinlay GA: Is the laparoscopic Palomo procedure for pediatric varicocele safe and effective? Nine years of unicentric experience. Surg Endosc; 2006; 20(4): 660-4.
Méndez-Gallart R, Bautista-Casasnovas A, Estevez-Martínez E, Varela-Cives R: Laparoscopic Palomo varicocele surgery: lessons learned after 10 years' follow up of 156 consecutive pediatric patients. J Pediatr Urol; 2009; 5(2): 126-31. th
Complications of Urology surgery,4 Edition, S Taneja, Elsivier publication
Beck EM, Schlegel PN, Goldstein M: Intraoperative varicocele anatomy: a macroscopic and microscopic study. J Urol; 1992; 148(4): 1190-4.
Rothman CM, Newmark H 3rd, Karson RA: The recurrent varicocele--a poorly recognized problem. Fertil Steril; 1981; 35(5): 552-6.
Cimador M, Castagnetti M, Ajovalasit V, Libri M, Bertozzi M, De Grazia E: Sub-inguinal interruption of dilated veins in adolescent varicocele: should it be considered a gold standard technique? Minerva Pediatr; 2003; 55(6): 599-605.
Agnifili A, Schietroma M, Carlei F, De Berardis B, Pescosolido A, Giuliani A, Venturoni A, Amicucci G: Recurrences, testicular growth and semen parameters after laparoscopic Palomo varicocelectomy. Chir Ital; 2008; 60(4): 549-54.
Kattan S. The impact of internal spermatic artery ligation during laparoscopic varicocelectomy on recurrence rate and short post operative outcome. Scand J Urol Nephrol; 2001; 35(3): 218-21.
Polok M, Patkowski D, Apoznański W, Dorobisz U, Laska E, Chrzan R: Electrocoagulation versus clips in laparoscopic varicocelectomy in boys. J Laparoendosc Adv Surg Tech A; 2009 Nov 6 [Epub ahead of print].
Tong Q, Zheng L, Tang S, Du Z, Wu Z, Mei H, Ruan Q: Lymphatic sparing laparoscopic Palomo varicocelectomy for varicoceles in children: intermediate results. J Pediatr Surg; 2009; 44(8): 1509-13.
Huk J, Fryczkowski M, Bihun M, Połać R: Laparoscopic varicocele ligation. The comparative assessment of artery-ligating and artery-preserving varicocelectomy. Wiad Lek; 2001; 54(11-12): 621-31.
Parrott TS, Hewatt L: Ligation of the testicular artery and vein in adolescent varicocele. J Urol; 1994;152(2 Pt 2): 791-3; discussion 793.
Student V, Zátura F, Scheinar J, Vrtal R, Vrána J: Testicle hemodynamics in patients after laparoscopic varicocelectomy evaluated using color Doppler sonography. Eur Urol; 1998; 33(1): 91-3.
Yamamoto M, Tsuji Y, Ohmura M, Hibi H, Miyake K: Comparison of artery-ligating and artery-preserving varicocelectomy: effect on post-operative spermatogenesis. Andrologia; 1995; 27(1): 37-40.
Matsuda T, Horii Y, Yoshida O: Should the testicular artery be preserved at varicocelectomy? J Urol; 1993; 149(5 Pt 2): 1357-60.
Fiedler U, Rost A: Studies on the reaction of the rabbit testis after ligation of the arteria and vena testicularis compared with ligation of the vein alone. Andrologia; 1976; 8(4): 351-4.
Ding H , Tian J, Du W, Zhang L, Wang H, Wang Z. Inguinal, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials. BJU Int. 2012 Nov; 110(10):1536-42.May-2012.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Sardar Rezaul Islam, Debobrato Paul, Shah Alam Sarkar, Sardar Saminul Islam, Mohammad Hanif
This work is licensed under a Creative Commons Attribution 4.0 International License.
