Varicocele. Ligation of the internal spermatic vein using laparoscopic approach

: It is now unquestionable that varicocele represents one of the main causes of male infertility, and thus requires appropriate surgical treatment. Inguinal and retroperitoneal methods have for some time been the most widely used. However, a significant postoperative morbidity and relatively long convalescence have prompted the search for alternative surgical techniques, such as percutaneous sclero-embolisation and microsurgery. Laparoscopic treatment of varicocele is a relatively recent surgical technique. The first studies by Sanchez de Badajoz date back to 1988 and to date a relatively small number of cases have been reported. The authors analyse the results in 54 patients treated over a period of two and a half years; 13 cases also presented inguinal hernia pathology which was treated during the same operation by applying a polypropylene graft again using a laparoscopic approach; the latter method has been routinely applied since 1992 in over 1000 cases with excellent results. The internal spermatic artery was always identified and preserved. No peri- or postoperative complications were observed. A follow-up was performed at 10 months after surgery and showed results which although referred to a relatively small series, were certainly better than those reported in the literature using traditional surgical techniques; in addition, this method also reveals interesting possibilities for the treatment of associated pathologies during the same operation, with obvious advantages in terms of costs and patient compliance.