Laparoscopic Varix Ligation

Donovan, James F.; Winfield, Howard N.

doi:10.1016/s0022-5347(17)37138-0

Cited by 177 publications

(52 citation statements)

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“…Other complications, e.g. hydroceles, are also more common due to simultaneous ligation of the lymphatics with the veins [4,14,21,22].…”

Section: Discussionmentioning

confidence: 99%

Subinguinal Microsurgical Varicocelectomy: Evaluation of the Results

Kumar

Gupta²

2003

Urol Int

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Introduction: Varicoceles have been established to be the commonest correctable cause of male infertility. Among the various methods available, microsurgical varicocelectomy has one of the lowest complication rates with low failure. Patients and Methods: Over a 4-year period, 100 patients underwent microsurgical varicocelectomy at our center. One hundred and forty-four surgeries were performed on 90 of these patients through a subinguinal approach and these form the study group. Only clinically diagnosed varicoceles were operated. Pre-operative semen values were compared with the post-operative values and statistical analysis performed using a non-parametric test. All 90 patients provided at least 1 post-operative semen report 3 months after surgery while 50 are on complete follow-up. Results: Sperm count improved in 71% patients, normal motility in 60% and normal morphology in 49%. Seventeen of the 50 patients on full follow-up (34%) achieved pregnancy, with 16 of these being spontaneous. All patients achieving pregnancy showed improvement in sperm count, 13 improved in motility and 12 in morphology. All improvements were statistically significant. There were 21 (14.6%) minor complications with no testicular atrophy and 1 recurrence. Conclusion: Microsurgical varicocelectomy is a safe and effective option for the managment of varicocele-induced male infertility. It leads to improvement in all semen parameters and increases the possibility of spontaneous pregnancies.

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“…Other complications, e.g. hydroceles, are also more common due to simultaneous ligation of the lymphatics with the veins [4,14,21,22].…”

Section: Discussionmentioning

confidence: 99%

Subinguinal Microsurgical Varicocelectomy: Evaluation of the Results

Kumar

Gupta²

2003

Urol Int

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“…Thus, a high peritoneal varicocelectomy approach through the abdomen is more effective because there are fewer and larger varicose veins. 13,14 Methods …”

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confidence: 99%

Laparoscopic Varicocelectomy: My Personal Experience of 4000 Cases

Chen

2016

International Surgery

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Varicocele accounts for 40% of male infertility. Laparoscopic varicocelectomy was used for the treatment of a series of 4000 men. The operation was a high bilateral ligation. The average time for the operation was 1 hour and 15 minutes. There were no complications and patients were discharged on the same day of the operation. Testicular damage from varicocele was permanent, and the usual percentage was 10% of total testicular tissue examined. The surgery was very well accepted by patients. Semen parameters improved among 80% of the patients, with 45% of their wives becoming pregnant. There is clearly a role for video laparoscopic varicocelectomy in the treatment of male infertility.Key words: Varicocele -Laparoscopic varicocelectomy -Male infertility -Abnormal semen I t is common knowledge that fertility is declining worldwide, with a rate of 25% among couples 1,2 ; of that number, the male contribution is conservatively at approximately 45%.3 While there are multiple causes in the male, one major cause is varicocele, which now cannot be ignored or even brushed off as controversial. In fact, both the American Society for Reproductive Medicine and the American Urological Association have found that varicocele causes infertility. 4 The incidence of varicocele can vary between 19% and 41% (the incidence is more reflective to that of 41%). 5,6 Varicocele has been shown not to begin at adulthood, but more likely at adolescence or 9 As a result of leakage, there is a backflow of renal blood down these veins. This renal reflux results in toxic damage to both spermatogenesis and male hormone production by the Leydig cell. 10Consequently, the testes are damaged in varying progressive stages over time. There is hyperthermia, testicular shrinkage and atrophy, sperm membrane damage, chromosomal breaks, spermatogenic arrest, maturation arrest, Sertoli cell destruction, and germinal epithelial sloughing. Male hormone production also declines, which affects health, and accelerates andropause. In its earlier subclinical stages, varicocele is diagnosed by Doppler ultrasound, whereas in its later more advanced clinical stages, the swollen veins become palpable. The condition is bilateral, but may appear to manifest unilaterally.When medically indicated for clinically significant varicoceles, many treatment options have been used over time.11 On the whole, the treatment for the varicocele is surgical by occlusion of the testicular veins. The previous common approach is the inguinal route, but there is a 40% recurrence rate. 12Scrotal varicocelectomy is not practiced because of its poor smaller vessels and poor results. Thus, a high peritoneal varicocelectomy approach through the abdomen is more effective because there are fewer and larger varicose veins. 13,14 Methods PatientsThis study involved 4000 laparoscopic varicocelectomies for infertility from 1995 15 to 2015. Their ages ranged from 26 and 68 years. The majority were in the age group of 30 to 34 years, with a 3-year history of infertility. These men had semen analysis. Ind...

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“…After 5 days of sexual abstinence, a semen sample was obtained by masturbation and allowed to liquefy at room temperature. The sperm concentration and motility were measured before and 3 months after laparoscopic high ligation of the internal spermatic vein [5]. We performed the Acrobeads test (FUSO Pharmaceutical Industries) as well as sperm motion analysis with a computer-assisted semen analyzer, CellSoft System 3000 (Cryo Resources, New York, USA; velocity, linearity, amplitude of lateral head displacement, beat cross frequency), in both the pre-and postoperative periods.…”

Section: Methodsmentioning

confidence: 99%