Outcome of Lymphatic- and Artery-Sparing Surgery for Pediatric Varicocoele

Abstract

This study shows good results with regard to postoperative hydrocoele rates. The preservation of the lymphatic supply ensures adequate lymphatic drainage, therefore, minimizing the risk of developing a hydrocele postoperatively. The risk of persistent varices, compared to the traditional en-masse technique, is a source of concern and requires further study.

Blue Patent Lymphography Prevents Hydrocele After Laparoscopic Varicocelectomy: 10 Years of Experience

“…25 Other reports have already been published in the international literature as for a LS procedure, but all the series are focused on small numbers of patients with a small or intermediate follow-up. 11,15,21,23,24 To the best of our knowledge, our series is the largest series published in the literature on this topic, with 396 patients operated on with a long follow-up of more than 10 years.…”

“…In particular, with Palomo repair the incidence of persistence/recurrence of varicocele seems lower than 5%, and the incidence of postoperative hydrocele seems to be higher than 30%. 7,[11][12][13] The lymphatic-sparing (LS) laparoscopic Palomo procedure of injecting isosulfan blue into the scrotum is one of the surgical options that has gained popularity in the last 10 years because it seems to reduce the occurrence of postoperative hydrocele with better identification of the lymphatic vessels. [14][15][16] However, based on an analysis of the international literature, only small series with a short or an intermediate follow-up have been published.…”

Varicocele Surgery: 10 Years of Experience in Two Pediatric Surgical Centers

“…21 A recent meta-analysis on pediatric varicocelectomy confirms that ligation of both artery and veins during laparoscopic varicocelectomy significantly reduces the recurrence rate. 35 This was similar to our study.…”

“…36 Artery-sparing ligation was also found to be associated with fewer hydroceles. 21 However, the rates of hydrocele are lowest after microsurgical techniques in adults. 32 In our study, it was found that laparoscopy and artery-sparing ligation were associated with higher rates of hydrocele.…”

“…19,20 Although there is a plethora of published articles on pediatric varicoceles in the last decade, studies reflecting surgical outcomes in the United Kingdom are limited to a small study of 19 cases. 21 In this study, we report on 10 years' experience of varicocele surgery in two pediatric surgical units and compare the outcomes of open versus laparoscopic techniques. We believe this is the largest series from the United Kingdom on pediatric varicocele surgery.…”