Varicocele: Should Internal Spermatic Artery Be Ligated?

Abstract

PURPOSE: Among numerous surgical techniques for varicocele correction, the retroperitoneal approach of Palomo had been modified from the ligation of internal spermatic vessels to the preservation of internal spermatic artery. We evaluate which is the preferable technique for varicocele correction between the internal spermatic artery-ligating and the artery-preserving operation. MATERIALS AND METHODS Between December 1989 and March 1999, 79 men with varicocele underwent surgical correction by the retroperitoneal approach. Group 1 and 2 were consisted with 24 patients who underwent internal spermatic artery ligating procedure, and 55 patients who underwent internal spermatic artery preserving technique respectively. Mean ages of both groups were 25.5 years (12-43) and 22.9 years (11-52) respectively. Most of the varicoceles were left sided (93.7%) and grade II (59.0%). The postoperative follow-up varied from 3 to 60 months with an average of 23.2 months. RESULTS There was no postoperative recurrence in group 1. In group 2, postoperative recurrence was seen in 9 patients (15.3%). The postoperative recurrence rate was significantly different in both groups (p=0.040). There was no postoperative testicular atrophy in both groups. Postoperative hydrocele was developed in 2 cases (8.3%) in the group 1, and 3 cases (5.1%) in the group 2. CONCLUSIONS This study shows that the artery ligation procedure is a safe surgery technique, because postoperative testicular atrophy is not occurred by ligation of the internal spermatic artery. Palomo method is the preferable technique because the postoperative reccurence rate which is the most serious complication in varicocele correction is significantly lower than that in modified Palomo technique.