[Surgical management of varicocele in childhood. A new modified surgical technique]

Conventional varicocelectomy is often complicated by postoperative recurrences. When failure occurs it is likely to be due to the incomplete interruption of the testicular vein(s) which is divided into multiple branches, or to the parallel collaterals, or to the incompetence of the cremasteric vein(s), or to the reversed flow in the deferential vein(s). We report our experience of 102 consecutive corrections of varicocele in adolescents (mean age 13.9/12 years) by personally modified technique. This technique is characterized by: unique ilioinguinal access to all venous districts as in retroperitoneum as in the inguinal canal; ligature and transection of internal spermatic vein(s) and parallel collaterals, external spermatic vein(s), deferential vein(s), if dilated; control of interruption of flow in these veins by blue methilen injection in a vein of pampiniform plexus. Optical magnification (3-4 X) and papaverine solution were also used. The rationale of this surgical approach is the interruption of all venous testicular outlet incompetent and potential incompetent, having a liberal alternative outlet in external pudendal vein(s) and in cross communications to avoid danger of venous insufficiency or recurrences. Easy and effective intraoperative control of venous interruption is also effected. No varicocele relapse or postoperative controlateral varicocele were detected (mean follow-up 11 months). The complications include an intraoperative bleu-methilen extravasation with large hematoma of cord and postoperative testicular atrophy and three postoperative hydroceles.