Laparoscopic versus inguinal (Ivanissevich) varicocelectomy

To compare the postsurgical outcome of laparoscopic and open inguinal varicocelectomy.

Quasi-experimental study.

Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2003 to June 2007.

One hundred seven patients underwent either open inguinal or laparoscopic varicocelectomy. Diagnosis was made by clinical examination and color Doppler scan in doubtful cases. Pre-operative semen analysis was done in all patients. Operative time, postoperative analgesic requirement in number of tablets, hospital stay in days, improvement in semen parameters in subfertile subjects, pain on visual analog score. and postoperative complications were recorded and compared between the two groups.

There were 50 patients in each group, with age ranging from 12-50 years (26.9+/-7.67 in open inguinal and 26.2+/-7.08 in laparoscopic group). Average operative time was 34.8+/-7.89 minutes for open inguinal and 43.8+/-8.95 minutes for laparoscopic group. The analgesic requirement was 16.3+/-1.58 tablets in the open inguinal and 11.3+/-2.23 in the laparoscopic group. Postoperative pain was significantly less in the laparoscopic group. There was statistically significant (p < 0.001) improvement in sperm count as well as motility in both groups irrespective of procedure.

The open inguinal (Ivanissevich) procedure and laparoscopic varicocelectomy had almost equivalent postoperative outcomes regarding improvement in semen parameters and postoperative complications. Open inguinal procedure had a shorter operating time while laparoscopic varicocelectomy had the advantage of less analgesic requirement and short hospital stay. On the whole, open inguinal (loupe magnified) varicocelectomy is an effective procedure where availability and costs of laparoscopic instruments are barriers.