Abstrait

Laparoscopic versus open inguinal spermatic vessel ligation in infertile men with varicocele

Shuang Liu, Chuanyi Hu, Ning Jiang, Guozeng Wang

Objective: Varicocele in infertile men is effectively treated by either Laparoscopic or Open Inguinal Spermatic Vessel Ligation (L-SVL and OI-SVL, respectively), but comparative information is limited. This retrospective study compared the outcomes and complications of L-SVL and OI-SVL.

Methods: Infertile men with varicocele were treated with L-SVL (n=140; 2001-2006) or OI-SVL (n=120; 2007-2012). Each patient had infertility>1 y; abnormal semen parameters; no other infertility-related disease; no obvious causes of infertility in the partner; and basal eco-color Doppler ultrasound showed continuous reflux in the spermatic vessel. Evaluations were conducted regarding rates of recurrence, intraoperative and postoperative complications, operative time, hospitalization, cost, and semen parameters 6 months after surgery.

Results: The demographics and preoperative (baseline) clinical features of the 2 groups were similar. Fewer men in the L-SVL group (0.83%) had recurrence of the varicocele after surgery compared with the OI-SVL group (2.86%, P<0.01), and men given L-SVL experienced significantly less time in surgery, recovery, and hospital stay. The groups were similar regarding rates of wound complications, damage to the genitofemoral nerve, testicular atrophy, epididymo-orchitis, and hydrocele, and procedural cost. Compared with the baseline, both groups showed significant postoperative improvements in sperm count, motility, and morphology (P<0.01), while the postoperative findings of the 2 groups were similar.

Conclusion: Both L-SVL and OI-SVL were effective in correcting varicocele in men, but L-SVL was associated with a lower varicocele recurrence rate, shorter hospitalization, better security, and healing rate.