From the Research
The best open surgical approach for bilateral varicocelectomy is the subinguinal microsurgical technique. This procedure involves making small incisions in the subinguinal area (just below the external inguinal ring) on both sides, followed by identification and ligation of the dilated veins while preserving the testicular artery and lymphatics using microscopic magnification. The procedure typically takes 45-90 minutes under general or spinal anesthesia and is usually performed as an outpatient procedure. Patients can expect to resume light activities within 48 hours and full activities within 1-2 weeks. Post-operative care includes scrotal support for 1-2 weeks, pain management with acetaminophen or NSAIDs as needed, and avoiding heavy lifting for 2-3 weeks.
The microsurgical approach is preferred because it offers lower recurrence rates (less than 2%), fewer complications such as hydrocele formation, and better preservation of testicular function compared to conventional approaches like the inguinal (Ivanissevich) or retroperitoneal (Palomo) techniques 1. The procedure also allows for better visualization of small collateral veins and lymphatics, reducing the risk of postoperative complications while effectively treating the varicocele. A study published in 2023 found that a modified Palomo procedure can improve serum testosterone levels and semen parameters in patients with varicocele 2, but the microsurgical approach is still preferred due to its lower recurrence rates and fewer complications. Another study published in 2024 compared two vascular division techniques in laparoscopic varicocelectomy and found that the laparoscopic Palomo technique is safe and effective, but the microsurgical approach is still the preferred method for open surgery 3.
Some key points to consider when performing a subinguinal microsurgical varicocelectomy include:
- Using microscopic magnification to identify and ligate the dilated veins while preserving the testicular artery and lymphatics
- Making small incisions in the subinguinal area to minimize scarring and promote faster recovery
- Avoiding heavy lifting and strenuous activities for 2-3 weeks after surgery to prevent complications
- Providing post-operative care, including scrotal support and pain management, to ensure a smooth recovery.
Overall, the subinguinal microsurgical technique is the best open surgical approach for bilateral varicocelectomy due to its low recurrence rates, fewer complications, and better preservation of testicular function.