ADOLESCENT VARICOCELE - OPERATIVE ANATOMY AND TRICKS FOR SUCCESSFUL CORRECTION

Conventional varicocelectomy is often complicated by high recurrence r ate, ranging from 6 to 25% and the persistence usually is due to resid ual venous communications. We report our experience of 21 years in var icocele correction using 3 different operative techniques on 389 adole scents. In the first 12 years (120 patients) a typical Ivanissevich op eration was carried out with a recurrence rate of 18%. In the followin g 4 years (63 patients) a preoperative venography was always carried o ut and a surgical procedure via an inguinal approach was performed wit h high retroperitoneal and inguinal ligations of the internal spermati c vein(s) and cremasteric vein(s) as indicated by venography; the recu rrence rate was still 8%. In the last 5 years we have been using a per sonally modified technique characterized by: 1) unique access to all v enous areas both in the retroperitoneum and in the inguinal canal with a systematic ligation of the internal and external spermatic veins an d the deferential vein when dilated; 2) intraoperative identification of the residual collaterals after venous ligations by injecting some m illiliters of a blue-methylene solution. This procedure allowed a vari cocele recurrence in only 2 out of 206 consecutive patients (1%). Our results suggest that it may be possible to lessen significantly the po stoperative recurrence rate using some simple operative tricks.