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Dye assisted lymphatic sparing subinguinal varicocelectomy. A prospective randomized study.

Mohamed E Abd Ellatif¹, Ayman El Nakeeb, Ashraf M Shoma

¹Mansoura University Hospital, General Surgery Department, Mansoura, Egypt. elnakeebayman@yahoo.com

International Journal of Surgery (London, England)

|August 31, 2011

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Methylene blue combined with optical magnification during varicocelectomy prevents hydrocele formation. This lymphatic sparing surgery reduces the incidence of secondary hydrocele without impacting testicular function or recurrence rates.

Area of Science:

Urology
Surgical Techniques
Vascular Surgery

Background:

Varicocelectomy can lead to hydrocele and testicular dysfunction due to lymphatic vessel damage.
Preventing lymphatic vessel division is crucial for reducing post-operative complications.

Purpose of the Study:

To evaluate the efficacy of methylene blue and optical magnification in preventing hydrocele after varicocelectomy.
To assess the impact of lymphatic sparing surgery on testicular function and recurrence.

Main Methods:

A randomized controlled trial involving 80 patients undergoing subinguinal varicocelectomy.
Group 1: Methylene blue injection with optical magnification. Group 2: Standard varicocelectomy without lymphatic mapping.
Patients were monitored for hydrocele, edema, recurrence, and other complications for 12 months.

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Main Results:

No hydrocele cases occurred in the methylene blue group (Group 1) versus four cases (10%) in the standard surgery group (Group 2; P=0.041).
No testicular hypertrophy or significant differences in varicocele recurrence or pregnancy rates were observed between groups.
The lymphatic staining technique demonstrated no intraoperative complications.

Conclusions:

Combining methylene blue lymphatic staining with optical magnification during subinguinal varicocelectomy is an effective method for preserving lymphatic vessels.
This technique significantly reduces the incidence of secondary hydrocele formation post-varicocelectomy.
The procedure is simple, quick, and avoids major complications.