Changing Concepts in Microsurgical Pediatric Varicocelectomy: Is Retroperitoneal Approach Better Than Subinguinal One?

Purpose: To compare and to assess two different microsurgical “lymphatic-sparing” techniques (subinguinal/inguinal vs. retroperitoneal) used for the treatment of a pediatric and adolescent varicocele in terms of success rate, complications and mean operative time. Materials and Methods: A retrospective study included 54 consecutive patients affected by a varicocele and treated with a microsurgical (loupes – operating microscope) magnification. Thirty-four out of 54 (group 1) underwent subinguinal ligation with the help of loupes magnification (× 3); 20 out of 54 (group 2) underwent retroperitoneal (Palomo like) ligation with preservation of lymphatics and with the help of an operating microscope (× 6 to 10). The two groups were homogeneous in terms of mean age, clinical and color Doppler ultrasound grade of disease. Pre- and post-operative testicular volume was measured in all cases. All the procedures were performed under general anesthesia and in an outpatient basis. Results: Mean post-operative follow-up time was 23.6 months. In group 1 we observed 3 (8.8%) early complications (wound’s infection, transient hydrocele), 2 (5.8%) recurrences and 1 (2.9%) major complication (atrophy of the testis). Mean operative time was 45 ± 6 min. In group 2 we did not observe complications and/or varicocele recurrence and mean operative time was 38 ± 7 min. Comparison of mean operative time between the two groups resulted statistically significant differences (P < .05) such as the difference in testicular “catch-up” growth volume between pre- and post-operative evaluations. Conclusion: Retroperitoneal microsurgical “lymphatic-sparing” varicocelectomy is safe and effective method. In our experience, it is preferable, in the pediatric and adolescent patient, to the subinguinal/inguinal approach in terms of success rate, complications and operative time duration.