title: The impact of internal spermatic artery ligation during laparoscopic varicocelectomy on recurrence rate and short post operative outcome.
abstract: OBJECTIVE
  To prospectively compare the recurrence rate and short postoperative outcome after randomized laparoscopic varix ligation with internal spermatic artery (ISA) preservation versus laparoscopic varix ligation with ISA ligation.
  
  
  METHODS
  Twenty-five patients with 35 varicocele who required varix ligation for infertility in 13 patients, scrotal pain in 15 patients and scrotal swelling in 2 patients who underwent one of two procedures: laparoscopic varix ligation with ISA prservation (Group A) or laparoscopic varix ligation with ISA ligation (Group B) were postoperatively evaluated for short post operative outcome and underwent percutaneous spermatic venograms to detect recurrence. Fisher's Exact Test was used for statistical analysis.
  
  
  RESULTS
  Recurrence through parallel collaterals was noted in 39% and 5.9% in Group A and Group B respectively as demonstrated on percutaneous spermatic venous venography (PSV) (statistically significant p = 0.0408). Preoperative pain completely resolved in all patients in Group B and persisted in 45% in Group A. However, this was not statistically significant (p = 0.088). No testicular atrophy or hydrocele formation was noted in either group.
  
  
  CONCLUSIONS
  Laparoscopic varix ligation with ISA ligation has lower recurrence rate than laparoscopic varix ligation without ISA ligation and may provide better varicocele related pain control with no increase in hydrocele or testicular atrophy rate. We recommend ISA ligation routinely during laparoscopic varix ligation.
authors.affiliation: King Saud University, and King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: S
authors.initials: S
authors.lastname: Kattan
mesh_terms: D001158:Arteries; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008026:Ligation; D008297:Male; D012008:Recurrence; D013085:Spermatic Cord / Q000098:blood supply; D013997:Time Factors; D016896:Treatment Outcome; D014646:Varicocele / Q000601:surgery*