Comparing two vascular division techniques in laparoscopic varicocelectomy. A prospective study

Area of Science:

• Pediatric Surgery
• Urology
• Vascular Surgery

Background:

• Varicocele, an abnormal dilatation of the pampiniform plexus affecting 15-20% of males, can lead to testicular hypertrophy and infertility.
• Accurate diagnosis and effective treatment of varicocele are crucial for preventing long-term reproductive health issues.

Purpose of the Study:

• To evaluate the safety and efficacy of the laparoscopic Palomo technique for pediatric varicocele repair.
• To compare postoperative complications and recurrence rates between two vascular occlusion methods: clipping + division versus vascular sealer.

Main Methods:

• A prospective, longitudinal study from 2017-2021 included 37 boys undergoing laparoscopic varicocelectomy.
• Patients were randomly assigned to either the clipping + division group (20 patients) or the vascular sealer group (17 patients).
• Outcomes analyzed included varicocele grade, postoperative complications (e.g., hydrocele), follow-up duration, and recurrence rates.

Main Results:

• The study included 37 boys (mean age 12 years) with a mean follow-up of 12 months; 24.3% had Grade II and 75.7% had Grade III varicocele.
• Postoperative complications occurred in 32.4% of patients, with hydrocele in 29.7% (8 from sealer group, 3 from clipping group), requiring re-intervention in 13.5%.
• No varicocele recurrence was observed in either group.

Conclusions:

• The laparoscopic Palomo technique is a safe and effective treatment for pediatric varicocele, yielding good outcomes with minimal complications.
• No statistically significant differences in complications or recurrence were found between the clipping + division and vascular sealer methods.
• Larger sample size studies are warranted to definitively identify potential differences between occlusion techniques.