Adolescent varicocele: operative anatomy and tricks for successful correction

Conventional varicocelectomy is often complicated by high recurrence rate, ranging from 6 to 25% and the persistence usually is due to residual venous communications. We report our experience of 21 years in varicocele correction using 3 different operative techniques on 389 adolescents. In the first 12 years (120 patients) a typical ivanissevich operation was carried out with a recurrence rate of 18%. In the following 4 years (63 patients) a preoperative venography was always carried out and a surgical procedure via an inguinal approach was performed with high retroperitoneal and inguinal ligations of the internal spermatic vein(s) and cremasteric vein(s) as indicated by venography; the recurrence rate was still 8%. In the last 5 years we have been using a personally modified technique characterized by: 1) unique access to all venous areas both in the retroperitoneum and in the inguinal canal with a systematic ligation of the internal and external spermatic veins and the deferential vein when dilated; 2) intraoperative identification of the residual collaterals after venous ligations by injecting some milliliters of a blue-methylene solution. This procedure allowed a varicocele recurrence in only 2 out of 206 consecutive patients (1%). Our results suggest that it may be possible to lessen significantly the postoperative recurrence rate using some simple operative tricks.