THE ADVANTAGES OF

LAPAROSCOPY COMPARED WITH

OPEN INGUINAL
VARICOCELECTOMY
Florin Iulian DUMITRACHE , Dan Teodor POTECA ,Daniela
Elena MIHAILA

Carol Davila University of Medicine and Pharmacy , Bucharest

,Romania
Clinical Hospital Colentina, Department of General Surgery Clinic II

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Varicocele is the varicose dilatation of

the pampiniform venous plexus and is
generally considered the most common
correctable cause of male infertility

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The indication for varicocelectomy includes testicular

volume discrepancy, chronic scrotal
pain and infertility without other apparent causes

The ideal procedure should perform a varicocelectomy

with a low rate of recurrence, hydrocele formation, and
testicular atrophy .
Laparoscopic varicocelectomy has gained popularity in
recent years in detriment of traditional open surgery due
to its minimally invasive nature , low morbidity, pain and
recovery time
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The aim of this work is to compare the postsurgical

outcome of laparoscopic and open subinguinal
varicocelectomy ,with regard to length of recovery ,
postoperative pain ,hydrocele recurrence and costeffectiveness
This clinical study enrolled 24 patients ,age 33-48
(median ~39 ) who underwent either open inguinal or
laparoscopic varicocelectomy in Clinical Hospital
Colentina, Department of General Surgery Clinic II,
Bucharest, between august 2013 and march 2014
In addition, in the laparoscopic group were 9 cases
varicocelectomy associated with abdominal hernia
repaired under the same anesthesia.
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By type of surgery, we divided the patients into 2 groups :

Group A ->laparoscopy
Group B ->open inguinal
Varicocelectomy

46%

Group A
54%
Group B

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OPERATIVE TECHNIQUE
Laparoscopic (Palomo)
A three-puncture technique is used with carbon dioxide
insufflation. The spermatic vessels are individually identified
and clips are used to ligate the veins. The spermatic artery is
preserved in all cases.
Open inguinal approach (Ivanissevich)
Incision is made one finger breadth above medial part
of inguinal ligament .The skin,fascia of external oblique
are cut.The cord is mobilized .Spermatic fascia is incised
and dilated veins are identified .Vas deference arteries
and two or three veins are separated and excised
between ligatures.The wound is closed in layers.
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1.1 Varicocelectomy -testicular vein denudation

1.2 Spigelian hernia -fixing the

surgical mesh

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The operations were successful in all the cases.

The postsurgical outcome was assessed by
physical examination of the scrotum for any
complications like persistence , hydrocele,
hematoma, recurrence , wound infection and
testicular atrophy in the follow up period
Analgesic requirements were determined by the
number of tablets recorded by the patient in the
postoperative period.
Data was recorded on a standardized data collection
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DATA
Nr pacient Age
1
35
2
38
3
40
4
48
5
44
6
34
7
38
8
41
9
40
10
33
11
37
12
46
13
38
14
39
15
43
16
38
17
36
18
40
19
42
20
41
21
38
22
35
23
39
24
40
MEAN AGE 39.29

Varicocelectomy
laparoscopic
open
laparoscopic
laparoscopic
laparoscopic
open
laparoscopic
laparoscopic
laparoscopic
open
laparoscopic
open
open
laparoscopic
laparoscopic
open
open
laparoscopic
open
open
laparoscopic
open
open
laparoscopic

Mean hospital stay

2
7
2
3
2
4
3
2
3
5
3
6
5
1
2
5
4
2
4
6
3
4
6
2

Hydrocele
no
no
yes
no
no
no
no
no
no
no
no
yes
no
no
no
yes
yes
no
no
no
no
yes
no
no

Associated surgery
yes
no
yes
no
yes
no
yes
yes
yes
no
no
no
no
yes
no
no
no
no
no
no
yes
no
no
yes

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Analgesic requirement(1-10 )
2
7
1
3
3
8
2
4
2
7
3
6
10
3
3
8
9
3
6
7
2
8
7
3

RESULTS
In this series, three patient in the open inguinal group and one
in laparoscopic group developed hydrocele. This finding is in
agreement with other studies which suggest that the
laparoscopic approach has less incidence of hydocele because
of better visualization of cord structures
Hydrocele recurrence (%)
18.18
20
18
16
14
12
10
8
6
4
2
0

7.69

laparoscopic

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open inguinal

RESULTS
The mean operative time of inguinal varicocelectomy was
significantly less than that of laparoscopic
varicocelectomy .

Mean operative time

OPEN INGUINAL

[VALUE]
min

LAPAROSCOPIC

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[VALUE]
min

RESULTS
However, the mean length of the postoperative
hospital stay was significantly less in the
laparoscopic group.
MEAN HOSPITAL STAY (DAYS)

4.83

Open inguinal

Laparoscopic

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2.33

RESULTS
The postoperative, analgesic requirement was
significantly less in the laparoscopic group than
the open inguinal group
Mean analgesic requirement(tablets )
OPEN INGUINAL

LAPAROSCOPIC

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10

12

14

16

RESULTS

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CONCLUSIONS
The laparoscopic approach is obviously superior to
open surgery for its advantages of minimal
invasiveness, fast recovery and less analgesic
requirement.

Also, it allows the surgeon to treat simultaneously

bilateral varicocele and abdominal hernia under the
same

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CONCLUSIONS
The open inguinal operation had the advantage of a
low cost , whereas laparoscopic varicocelectomy
had the advantage of less analgesic requirement and
a shorter hospital stay.
Furthermore, laparoscopic surgery requires more
extensive resources and general anaesthesia.

We recommend open inguinal operation as an

effective procedure where availability and costs
of laparoscopic instruments are barriers
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