INTRODUCTION: This retrospective study was designed to: (1) assess the perioperative and postoperative outcomes of patients following laparoscopic correction of varicocele; (2) compare the outcomes with a group of patients receiving open varicocelectomy; (3) describe predictors of surgical success following the laparoscopic procedure.
METHODS: Data were gathered between January 1998 and December 2008. Male partners of couples seeking care for infertility were evaluated. Those with a documented varicocele and semen analysis suggestive of severe oligospermia constituted the study cohort. A total of 245 patients underwent bilateral laparoscopic testicular vein ligation with a standard approach; 500 patients underwent open varicocelectomy. Patients were evaluated for semen profile and fertility every 3 months for 1 year and at 3 years postsurgery. Perioperative data, complications, semen parameters, fertility rates, and varicocele recurrence rates were compared for each surgical approach.
RESULTS: All patients receiving laparoscopic testicular vein ligation had a bilateral procedure. The mean operative time for patients receiving laparoscopy was 20 minutes (SD, 1.3; range, 15-25 minutes). The mean (SD) analgesic requirement was 1.6 (0.1) grams of paracetamol. The mean duration of the hospital stay was 13 hours (SD, 0.8; range 8-16 hours). When compared with open varicocelectomy, laparoscopy resulted in significantly less analgesic, shorter mean duration of surgery, and shorter mean hospital stay (all with P < .05). There were no statistically significant differences in the number of postoperative wound infections or hydroceles. Similarly, there were no significant differences in improvement of semen parameters, number of successful pregnancies, or number of recurrent varicoceles. One year following laparoscopic surgery, there was ≥ 50% improvement in sperm count in 182 males (74.3%), ≥ 30% increase in sperm motility in 219 males (89.4%), and ≥ 15% increase in normal sperm morphology in 190 males (77.6%). A total of 161 female partners (65.7%) reported a positive pregnancy test within 1 year of laparoscopic correction. Three patients had recurrent varicocele with secondary infertility that was corrected via an open approach.
CONCLUSION: Laparoscopic lymphatic-sparing testicular vein ligation is an effective option for management of infertility attributed to varicoceles. The short-term and long-term fertility outcomes are comparable to open approaches.
George P Abraham, Krishanu Das, George P Datson, Ramaswami Krishnamohan, Jisha J Abraham, Thomas Thachill, Oppukkeril S Thampan
Submitted August 10, 2010 - Accepted for Publication September 30, 2010
KEYWORDS: Laparoscopy; Oligospermia; Varicocele.
CORRESPONDENCE: Dr. Krishanu Das, Department of Urology, Lakeshore Hospital, NH 47 By-pass Maradu Nettoor PO, Kochi, Kerala, 6823040, India ( ).
CITATION: Urotoday Int J. 2010 Dec;3(6).
doi:10.3834/uij.1944-5784.2010.12.01