Laparoscopic surgery for pediatric varicoceles: Randomized controlled trial.

Background/purpose: The purpose of this investigation was to evaluate the advantages and the shortcomings of laparoscopic varicocelectomy compared with open traditional treatment of varicoceles.

Methods: A total of 654 patients were operated on for left-sided varicoceles over 5 years from 1995 to 2000. To evaluate the clinical efficiency of the treatment, the patients were divided randomly into 2 groups. Laparoscopic varicocelectomy (LV) was performed on 434 patients, and open varicocelectomy (OV) in 220 patients. Outcome data looked at relapse rate, presence of hydrocele, wound complications, and testicular or scrotal edema. Operating time, postoperative length of stay, and pain control also were compared. In both groups, the operations were performed by Palomo's technique with preservation of lymphatics and mass ligation of the artery and veins in the retroperitoneum above the internal inguinal ring.

Results: In LV versus OV, relapse rates were 1.84% versus 1.36 (P < 0.5), hydrocele occurrence was 0.23% versus 1.82% (P < 0.1), wound complication was 0.23% versus 7.73%, and testicular or scrotal edema was 3.9% versus 13.1%. LV hospital stay was an average of 3 days versus 7 days for OV. Operating time was 15 minutes for LV versus 26 minutes in open. Postoperative analgesic use was almost cut in half with LV.

Conclusion: The clinical efficacy of LV is superior to traditional OV.