Laparoscopic Versus Open High Ligation for Adolescent Varicocele: A 6-year Single Center Study.

OBJECTIVE: The aim of this study was to compare the outcomes of high ligation in adolescents with varicocele between open and laparoscopic surgical approaches.

DESIGN: Retrospective study.

SETTING: The study was conducted from January 2012 to January 2018, with median follow-up of 36 months, in the division of pediatric surgery at tertiary-care hospital.

PATIENTS: Data of 537 adolescents who underwent varicocelectomy were classified into two groups, depending on surgical approach.

INTERVENTION: Open or laparoscopic varicocelectomy.

MAIN OUTCOME MEASURES: Indications for surgery, complications, duration of surgery, hospital stay, and recurrences rate.

RESULTS: The median age of the patients was 15 years. The median (IQR) duration of surgery was 12 (11,15.3) min in laparoscopic and 25 (10,30) min in open group (P<0.001). The most common complication was hydrocele (n=29), which was more common in open group (6.8% vs 1.4%; P=0.01). A total of 16 recurrences were recorded, all in open group (P=0.049). In both groups, sperm concentration (P<0.001), morphology (P<0.001) and motility (laparoscopy, P=0.001; P=0.02; open varicocelectomy, P=0.001; P=0.04) improved six months after surgery in patients with varicocele stage I and II. In stage III there was an improvement in sperm concentration (P=0.002; P=0.001) and morphology (P=0.03; P=0.06), while sperm motility (P=0.15; P=0.2) did not significantly recover in either of the groups.

CONCLUSION: Laparoscopic and open varicocelectomy are equally effective and result in significant improvement of testicular volume, disappearance of pain, and sperm parameters in adolescents. Based on our findings laparoscopic varicocelectomy is associated with shorter operating time, shorter hospitalization, faster recovery, and fewer complications and recurrences.