Page 40 - WJOLS - Surgery Journal

Laparoscopic versus Various Types of Open Ligation of Testicular Veins for Treatment of Varicocele
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• In group 1: the benefits and how it could be instituted more widely. There
– 164 patients had LVL of which 6 patients developed is also diversity in quality of randomized clinical trials; the main
recurrence [3.8%]. variables in these trials are the following parameters:
• Also in group 1: Retropubic collateral channels were 1. No. of patients in trial.
identified in 7% cases during LVL. 2. Withdrawal of cases.
– Lateral collateral channels were identified in 17% cases 3. Exclusion of cases.
during LVL. 4. Blinding.
– All collaterals were interrupted by clipping or diathermy. 5. Publication.
Testicular artery was detected in 94% cases in group 18%]. 6. Intention to treat analysis.
Repair of right inguinal hernia [5 patients 3%]. 75% cases in 7. Local practice variation.
group 2. 8. Prophylactic antibiotic used.
9. Follow-up failure bias.
In group 1: Other procedures were concomitantly performed
including right orchidopexy [14 patients 8%]. Repair of right CONCLUSION
inguinal hernia [5 patients 3%].
In group 1: No intra-abdominal visceral or vascular injuries LVL is minimally invasive procedure that is easy to perform
with LVL. Three patients had pneumoscrotum which resolved with simple instrument, but other procedures like hernia repair
spontaneously within 24-48 hours? can be simultaneously performed. It is the best approach when
One patient in each group developed wound infection. recurrent disease and obesity are problems. The clear
Scrotal edema developed in 11 patients in group 2 compared visualization magnification facilitate detection of abnormal
to only 3 patients in group 1. collateral channels, one of major reasons for postoperative
In group 2: All required one or more narcotic injections after recurrences. LVL has minimal postoperative morbidity, shorter
surgery. convalescence and faster return to normal activity.
In group 1: Only 13% required one or more narcotic REFERENCES
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No testicular atrophy in any case of study regardless whether 3. Honig SC, Thompson S. Reassessment of male factor infertility
testicular artery was clipped or not. Improvement in seminal including varicocele, sperm penetration assay, semen analysis
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4. Koneru SR. Laparoscopic ligation of varicocele, an anatomically
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