Microsurgery and varicocele: State of the art

Puleo, Stefano; Trombatore, Giovanni; Lombardo, R.; Greco, Luigi; Rodolico, Margherita; Cataldo, Antonio Di

doi:10.1002/(sici)1098-2752(1998)18:8<479::aid-micr10>3.0.co;2-b

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…Median age of patients that underwent microsurgical bypass was 16 years (range [12][13][14][15][16][17]. Average follow-up was 10 months (range 6-12), and it is being continued as an ongoing project.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies that analyzed the results of spermatico-epigastric venous bypass for varicocele treatment were done in pediatric patients with significant testicular mass loss. 14 All have shown excellent long-term bypass patency and reversal of testicular hypotrophy after the procedure, but the true effect is difficult to ascertain since a certain proportion of adolescents with varicocele testicular hypotrophy recover testicular mass spontaneously due to catch-up growth.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13] This method has excellent long-term results, especially in pediatric patients with testicular hypotrophy. 14 The idea behind the bypass is to ligate and reroute the main internal spermatic vein toward the femoral or iliac vein. The remaining internal spermatic veins that had not been ligated, communicate with the main internal spermatic vein through collateral pampiniform connections, so if any venous reflux persists, it is also rerouted into the bypassed vein without reaching the testicle.…”

Section: Introductionmentioning

confidence: 99%

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Internal Spermatic Vein to Superficial Epigastric Vein Microsurgical Bypass in Varicocele Treatment

et al. 2022

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Introduction Identification and preservation of testicular artery and lymphatic vessels during microsurgical varicocelectomy can be tedious if adhered encompassing venous network is encountered. A venous bypass from internal spermatic to saphenous or inferior epigastric vein, that have been described for varicocele treatment, may be used in such situations. This paper describes a simplified modification of the venous bypass technique that reroutes the testicular blood to the superficial epigastric vein, which can easily be found in the incisional wound. Surgical technique and anastomotic patency test are described, and indications and results are discussed. Materials and Methods During 2020 and 2021, 32 adolescent patients underwent microsurgical varicocelectomy. In eight patients additional microsurgical testicular vein-superficial epigastric vein microvascular bypass was done. The indication for bypass was difficult identification of testicular artery and/or lymphatic vessels due to adhered venous plexus. Results Varicocele resolution was noted in all eight patients with clinical and/or semen analysis improvement. There were no complications or recurrences. Average length of procedure was 65 minutes. All patients were discharged within 24 hours and no antiplatelet or anticoagulant therapy was used. Conclusion Testicular vein to superficial epigastric vein anastomosis is a useful and simplified venous bypass technique that reroutes the blood from the pampiniform plexus to the femoral vein. It can be done as an adjunct to microsurgical varicocelectomy in selected patients through a standard incision.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Internal Spermatic Vein to Superficial Epigastric Vein Microsurgical Bypass in Varicocele Treatment

et al. 2022

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Laparoscopic Treatment of Pediatric Varicocele: A Multicenter Study of the Italian Society of Video Surgery in Infancy

et al. 2000

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Our preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. However, the important advantages of laparoscopy over the open approach are its minimal invasiveness and precision of intervention. Moreover, laparoscopy allows treatment of other intra-abdominal pathological conditions using the same anesthesia, as in 10 patients in our series. We believe that ligating the testicular veins and artery is preferable to ligating the testicular veins only, even if the incidence of hydrocele is not negligible after the Palomo procedure.

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