Subinguinal microsurgical ligation--its effectiveness in pediatric and adolescent varicocele

Treatment of varicocele using a microsurgical vein ligation approach is a successful procedure when applied to adult patients. We performed this procedure in prepubertal and pubertal patients in order to verify its feasibility and effectiveness in a younger population.

Between January 1998 and December 1999, 46 patients (average age 13 years) were operated on for a left varicocele using a microsurgical selective vein ligation procedure. All patients were evaluated clinically and using color Doppler ultrasound (CDUS): 34/46 patients were classified clinically as grade III and the remaining 12 as grade II. We used a magnification loupe (x3) in 34/46 patients and an operating microscope (x 10-16) in the remaining 12.

The procedure was successful in all but one patient (2.1%) who showed recurrence of the disease at the time of the first postoperative follow-up CDUS scan and required a repeat procedure. The average operative times were 45 and 60 min for loupe and microscopic procedures, respectively. In three cases (6.5%), early postoperative complications (wound infection and transient hydrocele) occurred and quickly resolved. All the patients were discharged within 24 h, returned to normal daily life within 2 days and resumed physical and sporting activities within 1 week.

Subinguinal "artery- and lymphatic-sparing" microsurgical varicocelectomy, considered the gold standard treatment in adults, also proved to be successful in this preliminary experience with pediatric patients. The minimally invasive approach ensures the prevention of recurrences and/or postoperative complications, and is associated with a very low morbidity rate.