THE INFLUENCE OF SURGICAL APPROACH AND INTRAOPERATIVE VENOGRAPHY ON SUCCESSFUL VARICOCELECTOMY IN ADOLESCENTS

Purpose: We evaluated the importance of intraoperative venography and surgical approach on varicocele recurrence after surgical varicocelect omy in male adolescents. Materials and Methods: The analysis was done using local data and composite data from the literature. We reviewed t he records of patients undergoing varicocele ligation between 1986 and 1995 at our institution. Data were stratified by surgical approach an d performance of venography, and compared by cross table analysis. Dat a were then compiled from the literature from series that included cas es stratified according to surgical approach and/or performance of ven ography. The impact of these parameters on recurrence rates was assess ed by computing success rates and cross table analysis. Results: At ou r institution 33 boys underwent ligation via a suprainguinal (27) or i nguinal (8) approach. Intraoperative post-ligation venography was perf ormed in 16 cases and omitted in 19. Neither surgical approach nor per formance of venography influenced the recurrence rate in these patient s (not statistically significant). Similarly, venography did not affec t the recurrence rate after stratification by surgical approach (not s ignificant). The overall success rate was 97% (34 of 35 cases). These data were added to those of 3 published studies, totaling 252 varicoce les with comparable groupings. Mean success rate after a suprainguinal and inguinal approach was 95.6 (93.2 to 97.4) and 88.3% (82.7 to 100% ), respectively. Recurrence tended to be less common after a supraingu inal than an inguinal approach (p = 0.06). Post-ligation venography di d not statistically affect the success rate after stratification accor ding to surgical approach but it was associated with a higher success rate when performed with the inguinal approach. Conclusions: Irrespect ive of the performance of venography, the suprainguinal surgical appro ach yields higher success rates than the inguinal approach to varicoce les in adolescents. Post-ligation intraoperative venography fails to a ffect significantly the success rate of varicocele ligation but it may be useful during an inguinal approach.