INCIDENCE AND PATTERN OF VARICOCELE RECURRENCE AFTER LAPAROSCOPIC LIGATION OF THE INTERNAL SPERMATIC VEIN WITH PRESERVATION OF THE TESTICULAR ARTERY

Objectives: To determine the incidence and pattern of recurrence of va ricocele after laparoscopic internal spermatic vein ligation with test icular artery preservation. Methods: In a prospective study, 16 patien ts who underwent 20 laparoscopic varix ligation were evaluated postope ratively for recurrence by clinical physical examination and percutane ous spermatic venography. Results: No significant complications were e ncountered with the surgical or radiological procedure. Clinical recur rence was detected by physical examination in 20% of cases, while perc utaneous spermatic venography detected recurrence in 45% of cases. The sensitivity and specificity of clinical physical examination for dete cting varicocele recurrence was 33% and 90.9%, respectively with an ac curacy rate of 65%. Recurrences were through parallel collaterals or m edial transverse collaterals in 88.8% and 11.2%, respectively. Paralle l collaterals joined the spermatic vein in mid or high retroperitoneum in seven patients while it joined the renal vein in one patient. Ther e were no low retroperitoneal parallel collaterals. Conclusions: Lapar oscopic ligation of internal spermatic vein with preservation of testi cular artery is a procedure that is associated with low morbidity and quick recovery. It is able to achieve its surgical objective in only 5 5% of cases, however. Such information should be taken into considerat ion during patient counselling when selecting the operative technique of choice for varicocele ligation.