[Varicocele: endoscopy versus surgery]

Varicocele is a frequent and benign pathology, well known since the antiquity, his treatment has progressed by a better acquaintance of physiology and the effects on fertility. In the surgery department of FSI hospital, we compared the results of 2 surgical methods: the Ivanisevich's technique (open surgery) and the laparoscopic approach. The objective was to compare morbidity, recurrence rate, hospital stay, and effects on pains and fertility. From May 1993 to December 1998 we treated 72 patients with symptomatic varicocele: 40 patients by laparoscopy and 32 by open surgery. The recurrence rate was of 32% for surgery and 21% for laparoscopy. But duration of surgical operation was longer for laparoscopy: 50 mn against 30 mn for unilateral cure and 70 mn against 55 mn for bilateral cure. We did not observe a difference between the 2 groups in hospital stay, morbidity, pains and fertility. At the end of the study we propose laparoscopy for bilateral cure and open surgery for unilateral. Decrease of recurrences needs the realisation of a phlebography before surgery, but this investigation weight routinely "take charge" of patients; we reserve it to recurrences. Echography coupled to Doppler is essentially used for preoperative diagnosis of varicocele and for surveillance of postoperative recurrences.