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Updated: Oct 18, 2026
Combination of High Ligation and Intraoperative Embolization Using Polidocanol for Treatment of Varicoceles
Published on: December 22, 2023
[Idiopathic varicocele. Ligature of the reflexive vessels to the internal inguinal ring]
P Sperlongano1, I Corsale, D Pisaniello
1Istituto di Patologia Speciale Chirurgica e Propedeutica Clinica, Il Università degli Studi di Napoli.
Insights
Idiopathic varicocele contributes to male infertility. This study highlights inguinal varicocele repair using intraoperative Doppler to preserve the spermatic artery and non-refluxive veins, improving outcomes.
Area of Science:
- Urology
- Andrology
- Vascular Surgery
Background:
- Idiopathic varicocele is a significant cause of male sterility, affecting 40-50% of cases.
- Previous surgical techniques like high spermatic vein ligation (Ivanissevich) and Palomo procedures, as well as microsurgical anastomoses, have shown high rates of varicocele persistence.
- Anatomic variations identified by Coolsaet in the 1980s explain the recurrence or persistence of varicocele post-surgery.
Purpose of the Study:
- To review the experience of surgical treatment for idiopathic varicocele in 371 patients.
- To evaluate the efficacy of inguinal ligature of refluxive venous vessels.
- To emphasize the importance of intraoperative Doppler guidance in varicocele surgery.
Main Methods:
- Review of 371 patients surgically treated for idiopathic varicocele via inguinal ligature of refluxive venous vessels.
- Utilization of intraoperative Doppler ultrasound during surgery.
- Focus on preserving the spermatic artery and non-refluxive venous vessels.
- Attention to lymphatic preservation during the procedure.
Main Results:
- Inguinal ligature of refluxive venous vessels, guided by intraoperative Doppler, allows for the preservation of the spermatic artery.
- Non-refluxive venous vessels can be identified and preserved.
- The technique emphasizes the need for lymphatic preservation.
- This approach aims to reduce varicocele recurrence and persistence.
Conclusions:
- Intraoperative Doppler is crucial for successful idiopathic varicocele surgery.
- Preserving the spermatic artery and non-refluxive veins, along with lymphatics, is key to improving surgical outcomes.
- Inguinal ligature of refluxive venous vessels offers a refined approach to managing idiopathic varicocele.
Abstract:
The idiopathic varicocele is involved in 40-50% of the male sterility. The angiographic studies undertaken by Coolsaet in the 1980 have showed the different anatomic conditions that are at origin of the varicocele, explaining the recurrence or persistence of the illness after surgical operations. The high ligature of spermatic vein (Ivanissevich), eventually with ligature of spermatic artery also (Palomo), and the micro-surgical anastomoses result in high percentage of varicocele persistence. On the basis of such considerations, the Authors reviewed their experience on 371 patient surgically treated for idiopathic varicocele by inguinal ligature of the refluxive venous vessels. They emphasize the role of the intraoperative Doppler, that consents preserving spermatic artery and not-refluxive venous vessels, and need to respect the lymphatics.
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