Laparoscopic treatment of pediatric varicocele: A multicenter study of theItalian Society of Video Surgery in Infancy

Purpose: We report preliminary results of a multicenter study of the Italia n Society of Video Surgery in Infancy on the laparoscopic treatment of pedi atric varicocele. Materials and Methods: A total of 161 children 6 to 16 years old (median ag e 12.5) underwent laparoscopic treatment of varicocele at 6 pediatric surge ry divisions. Varicocele was on the left side in 159 cases (98.7%) and bila teral in 2 (1.3%), Two boys had recurrent left varicocele, All children wer e treated with laparoscopy, including ligation of the spermatic veins only in 28 (17.3%), and ligation of the testicular veins and artery in 133 (82.7 %). In 10 boys (6.2%) an additional procedure was done simultaneously, incl uding closure of an apparently patent peritoneal vaginal duct on the right side in 7 and resection of epiploic adhesions between the intestinal loops and abdominal wall from previous appendectomy in the remaining 3. Results: Average operative time was 30 minutes and hospitalization was abou t 24 hours. At followup there were 13 minor complications (8%), including l eft hydrocele in 9 children who underwent the Palomo technique, minor scrot al emphysema in 2 and umbilical granuloma in 2. In our series varicocele re curred in 1 boy (3.5%) who underwent ligation of the spermatic veins only a nd in 3 (2.2%) treated with the Palomo technique. Conclusions: Our preliminary experience shows that the results of the lapar oscopic approach are comparable to those of the open approach. However, the important advantages of laparoscopy over the open approach are its minimal invasiveness and precision of intervention. Moreover, laparoscopy allows t reatment of other intra-abdominal pathological conditions using the same an esthesia, as in 10 patients in our series. We believe that ligating the tes ticular veins and artery is preferable to ligating the testicular veins onl y, even if the incidence of hydrocele is not negligible after the Palomo pr ocedure.