Results and complications of laparoscopic surgery for pediatric varicocele

Background: The aim of this study was to evaluate the results and complicat ions of laparoscopic varicocelectomy in children. Methods: Over a 36-month period, 211 children underwent laparoscopic treatm ent of varicocele. Their ages ranged between 6 and 17 years; the varicocele was located on the left side in 209 cases (99.1%) and was bilateral in 2 ( 0.9%). In 195 patients the laparoscopic transperitoneal a pp roach was used and in 16 retroperitoneoscopy was used. Thirty children (14.2%) underwent ligation of the veins alone, and 181 (85.8%) underwent ligation of testicul ar veins and artery. In 15 (7.1%) cases an additional procedure was applied during the same operation. Results: Average operating time was 30 minutes and hospitalization about 24 hours. At an average follow-up of 26 months, there were 19 (9%) postoperat ive complications: 14 children had a left hydrocele, 3 children a scrotal e mphysema, and 2 an umbilical granuloma. There were 5 recurrences of varicoc ele in our series: 2 (2 of 30, 6.6%) after the Ivanissevitch procedure, and 3 (3 of 181, 1.6%) after Palomo's. Testicular atrophy did not occur in any patient of this series. Conclusions: This preliminary experience shows that the results of the lapa roscopic approach are comparable to those of the open approach. The ligatio n of testicular veins and artery is preferable to the ligation of the testi cular veins alone. Hydrocele seems to be the most frequent postoperative co mplication and a potential problem, especially in children operated on with the Palomo procedure. J Pediatr Surg 36:767-769. Copyright (C) 2001 by W.B . Saunders Company.