POSTSURGICAL OUTCOMES ASSESSMENT FOLLOWING VARICOCELE LIGATION - LAPAROSCOPIC VERSUS SUBINGUINAL APPROACH

Objectives. To prospectively compare and objectively assess the postsu rgical outcome parameters of both laparoscopic and open subinguinal te chniques for varicocele ligation in infertile men. Methods. A total of 41 evaluable patients with a history of infertility, abnormal semen a nalysis, and clinically diagnosed varicoceles underwent surgical ligat ion either by the insufflative intraperitoneal laparoscopic (n = 15), gasless laparoscopic (n = 7), or the open subinguinal (n = 19) approac h. Most procedures (39 of 41) were performed in the outpatient setting , and patients were followed postoperatively for a minimum of 6 months . Postsurgical outcome was assessed by physical examination and review of a patient questionnaire quantifying the graded pain severity, anal gesic requirements, and number of days to return to work. Results. The average operative time was 82.3 +/- 26.5 minutes for insufflative int raperitoneal laparoscopic varicocelectomy, 170 +/- 55 minutes for gasl ess laparoscopic varicocelectomy, and 35.6 +/- 13.5 minutes for the op en subinguinal approach. The analgesic requirement was 13.7 +/- 9.9 ta blets for the insufflative laparoscopic group, 22.5 +/- 11 tablets for the gasless laparoscopic group, and 10.9 +/- 10.3 tablets for the ope n subinguinal group. The average number of days to return to work was 4.9 +/- 2.7 for the insufflative group, 6.6 +/- 2.6 for the gasless gr oup, and 5.1 +/- 3.7 for the open subinguinal group.Conclusions. These results show no superiority of laparoscopic techniques over the stand ard open subinguinal technique with respect to hospital stay, analgesi c requirements, or return to work. Laparoscopic techniques require exc essive operative time, may have attendant complications, and require g eneral anesthesia, limitations that preclude their routine application in varicocele ligation. However, the laparoscopic approach may have a role in the setting of other concurrently performed laparoscopic proc edures. (C) 1998, Elsevier Science Inc. AII rights reserved.