Laparoscopic simultaneous ligation of internal and external spermatic veins for varicocele

The conventional treatment of varicocele consists of interruption of reflux in the internal spermatic vein either by open retroperitoneal high ligation, an open inguinal approach or percutaneous embolization. Recently, high ligation of the internal spermatic vein has been performed via laparoscopy. We previously suggested that ligation of the internal spermatic vein alone is not adequate, and a comparative study has shown that our method of trans-inguinal ligation of the internal and external spermatic (cremasteric) veins yields better surgical results. A laparoscopic version of this operation is described, which was performed in 25 patients for 31 ligations (6 bilateral cases). Short-term results (followup at 3 months) have shown that the procedure is safe and effective (no complications, 24-hour hospitalization and 1 case of persistence due to a technical error). This procedure seems to be an attractive alternative to our trans-inguinal combined approach especially if bilateral ligation is necessary.