title: Inguinal versus subinguinal varicocele vein ligation using magnifying loupe under local anesthesia: which technique is preferable in clinical practice?
abstract: OBJECTIVE
  To compare the intraoperative results of inguinal versus subinguinal varicocelectomy using magnifying loupe, in terms of vein ligation and arterial preservation, recurrence rate, and patient tolerability.
  
  
  METHODS
  Ninety-nine patients were randomized to undergo a varicocele repair with an inguinal or a subinguinal approach under local anesthesia. Data concerning the number of veins ligated and arterial preservation were recorded during each procedure. The amount of intraoperative and postoperative pain was assessed by means of visual analogue scale (VAS) scores. The recurrence rate was documented by color Doppler ultrasound examination.
  
  
  RESULTS
  The average number of ligated veins was 5.6 with a subinguinal dissection and 4.4 with the inguinal approach. Inadvertent injury of the spermatic artery occurred in 6 of 47 subinguinal and 3 of 50 inguinal dissections; the artery could not be identified during 2 subinguinal and 1 inguinal dissection. Recurrent varicocele was detected in 8% and 14.9% of patients after an inguinal and a subinguinal approach, respectively. The intraoperative VAS score was significantly higher in the inguinal than in the subinguinal patients (P = 0.008).
  
  
  CONCLUSIONS
  In our hands, the inguinal approach to the spermatic cord showed a trend toward an easier preservation of the artery and a reduced incidence of persistent pathologic vein reflux. The subinguinal approach had a lower degree of intraoperative pain. On the whole, an inguinal repair might be preferable when magnifying loupe are used for varicocelectomy.
authors.affiliation: Clinica Urologica, Università del Piemonte Orientale, Novara, Italy. paolo.gontero@med.unipmn.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.forename: Giuliano
authors.initials: G
authors.lastname: Pretti
authors.forename: Francesco
authors.initials: F
authors.lastname: Fontana
authors.forename: Andrea
authors.initials: A
authors.lastname: Zitella
authors.forename: Giansilvio
authors.initials: G
authors.lastname: Marchioro
authors.forename: Bruno
authors.initials: B
authors.lastname: Frea
mesh_terms: D000328:Adult; D000772:Anesthesia, Local; D006119:Groin; D006801:Humans; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D008297:Male; D013737:Testis / Q000098:blood supply; D014646:Varicocele / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods; D014680:Veins