Complication rate of microsurgical varicocele ligation without delivery of the testis

It is commonly assumed that the complication rate of microsurgical varicocele repair is lower than that of nonmicrosurgical techniques, particularly since magnification allows for preservation of lymphatic vessels and, thus, a theoretically lower incidence of hydrocele. However, review of the literature reveals relatively few papers on this subject. The authors reviewed their experience to determine the incidence of complications following microsurgical varicocele repair without delivery of the testicle in the adult population. From 1 July 1997 to 1 September 2001 139 men underwent microsurgical varicocele ligation without delivery of the testicle, with a mean follow-up of 22 months. Of the 139 men, 4 (2.9%) had complications. One (0.7%) had a recurrence, 1 (0.7%) had a wound infection, 1 (0.7%) had epididymitis, and 1 (0.7%) had an unintentional injury of the testicular artery. None of the men developed a hydrocele. The published complication rate for nonmicrosurgical varicocle ligation ranges from 5.4 to 7.2%, with the most common complication being hydrocele formation. In the authors' series, the overall complication rate was 2.9%, with no patient developing a hydrocele. Thus, microsurgical varicocele ligation without delivery of the testicle results in a lower complication rate and a lower incidence of hydrocele than nonmicrosurgical techniques.