[Day surgery management of varicocele with Doppler-assisted dissection at the external inguinal ring (subinguinal...

We performed a total of 172 varicocelectomies with the subinguinal technique in 151 patients. Of these, 129 patients (85%), undergoing a total of 140 varicocelectomies, were monitored for at least one year (11 had bilateral varicocele) with a mean follow-up of 3 years. Ninety-nine of these (77%) presented preoperative semen abnormalities and 62 (48%) had infertility problems. The diagnosis of varicocele was confirmed in all cases with a duplex ultrasound examination. The morbidity rate was low: 26 patients (20%) presented epididymal discomfort, and 9 patients (7%) ecchymosis in the wound site and/or scrotum, while in 5% (4 patients) of the 140 varicoceles operated on we observed a temporary reactive hydrocele; in 1 case (0.7%) the hydrocele persisted for one year postoperatively. One case (0.7%) presented persistence of varicocele. The following semen variables were evaluated before and after the operation: number of spermatozoa per ml, motility, percentage of morphologically normal spermatozoa. In 70% of patients (70 cases) with alterations of semen variables we observed a statistically significant postoperative improvement in these variables. The spontaneous pregnancy rate one year postoperatively, in those cases where the couple had fertility problems, was 35.5% (22 pregnancies). We believe that the technique using the subinguinal approach is a safe, simple procedure and therefore that it should be regarded as the gold standard in the management of varicocele, in that it allows the simultaneous ligature of the internal and external branches of the spermatic vein. This technique can be performed in the day-surgery setting with minimal invasiveness and at extremely low cost compared to other procedures. This technique is the procedure of choice not only in the treatment of varicocele but also, above all, in the treatment of varicocele recurrence or persistence.