Varicocelectomy in adolescent boys: long-term experience with the Palomo procedure

We report our long-term experience with the Palomo technique for varicocele ligation in the pediatric population.

Between August 1986 and December 2006, 312 patients 7 to 21 years old (median age 14.6) underwent varicocele ligation using the Palomo technique for complete retroperitoneal ligation of the internal spermatic veins and artery. In 234 patients the varicocele was grade III, in 75 it was grade II and in 3 it was grade I. Indications for surgery were relative left testicular volume loss compared to the right testicle in 248 patients, bilateral palpable varicoceles in 8 and pain or parental preference in the remainder. Postoperative followup was 2 weeks to 10.6 years (mean 17.4 months). A total of 233 patients had at least a 6-month followup.

Persistent varicocele was noted in 9 of 233 patients (3.9%). Of the 233 patients 68 (29%) presented with a secondary hydrocele an average of 14 months (range 18 to 1,964 days) following surgery, of whom 12 (17.6%) underwent hydrocele correction. The 12 patients who underwent hydrocelectomy represented 5% of the patients with varicocelectomy. Postoperative testicular atrophy was not documented in any patient and no other surgical complications were noted.

The Palomo procedure for adolescent varicocele repair is safe and effective with a high success rate and low complication rate. Postoperative hydrocele formation developed in 29% of our patients. However, most secondary hydroceles were small, asymptomatic and did not require surgical correction.