[Laparoscopic spermatic vein occlusion with Hem-o-lock clips versus Palomo procedure for primary varicocele]

To evaluate the clinical effects of laparoscopic occlusion of the internal spermatic vein with Hem-o-Lock clips and retroperitoneal ligation of the spermatic vessel (Palomo procedure) in the treatment of primary varicocele.

We included in this study 42 varicocele patients treated by laparoscopic occlusion of the internal spermatic vein with Hem-o-Lock clips (Hem-o-Lock group) and another 38 treated by Palomo procedure (Palomo group). We recorded the operation time, intraoperative blood loss, hospital stay, bowel function recovery time, post-operative complications, as well as such seminal parameters as sperm concentration, sperm motility, sperm abnormality and the percentage of grade a + b sperm 6 months after surgery. We measured the interior diameter and reflux time of the spermatic vein and the ratio of flow velocity to the diameter using color Doppler flow imaging (CDFI), and observed the disappearance and recurrence of clinical symptoms.

Intraoperative blood loss was markedly less and the operation time, postoperative hospital stay and intestinal function recovery time significantly shorter in the Hem-o-Lock than in the Palomo group (P<0.05), but there were no statistically significant differences in the incidence of postoperative complications (P>0.05). Six months after surgery, seminal parameters and the results of CDFI were significantly improved in both the Hem-o-Lock and Palomo groups (P<0.05), but with no significant difference between the two (P>0.05). No recurrence was found in either group at 18 months.

Both laparoscopic spermatic vein occlusion with Hem-o-Lock clips and Palomo procedure can improve the semen quality and relieve the clinical symptoms of primary varicocele patients, but the former is even more preferable for its shorter operation time and hospital stay, less intraoperative bleeding, fewer complications, better clinical outcomes, and lower rate of recurrence.