Minimally invasive approach for the treatment of idiopathic varicocele

Laparoscopic ligation of the spermatic veins represents a new approach for the treatment of the idiopathic varicocele. This procedure was performed in 28 consecutive patients. The diagnosis was based on physical examination and Doppler ultrasonography. The indications for surgery were (a) infertility and abnormal semen analyses (15 patients), (b) scrotal pain (six patients), and (c) psychological reasons (seven patients). One patient underwent concomitant hernioplasty. Two cases presented with a recurrence after 6 and 12 months, respectively. The mean operative time was 34 +/- 11 min in unilateral cases and 47 +/- 9 min in bilateral cases. In one patient with left inguinal hernia and varicocele, the operative time was 70 min. All patients were discharged the day after operation without antibiotics and analgesics and resumed normal activity within 5 to 9 days, depending on age and occupation. Postoperative semen analyses (at 12 months' follow-up) were obtained from seven patients and demonstrated an improvement in semen motility (preoperative 40% versus postoperative 56%). This study confirms that laparoscopic treatment of varicocele is safe, minimally invasive, and, according to National Health Service fees, less costly than radiological occlusion procedures.