Lymphography prior to laparoscopic Palomo varicocelectomy to prevent postoperative hydrocele.
We report our experience with preoperative lymphography to identify and perioperatively preserve the ligature of the lymphatic vessels to reduce the incidence of postoperative testicular hydrocele in patients undergoing laparoscopic Palomo varicocelectomy for adolescent varicocele.



Twenty-seven consecutive patients with varicocele had preoperative lymphography. The mean age was 13.5 years (range, 8-18 years) and the mean grade of varicocele was III. We performed lymphography with intrascrotal isosulfan blue. The laparoscopic Palomo procedure was successfully carried out in all patients.



In 17 patients (63%) we were able to identify and conserve the lymphatic vessels by lymphography. Mean follow-up was 9.5 months (range, 6-24 months). None of the 27 patients had a recurrence. None of the 17 patients with positive lymphography had a testicular hydrocele. One of the 10 remaining patients developed a sizable hydrocele.



Preoperative lymphography prior to laparoscopic Palomo varicocelectomy is a simple and feasible method for preventing testicular hydrocele. However, the method should be standardized to identify the exact site, the correct level of injection of blue dye, and to determine the optimal time to perform lymphography prior to the procedure.
Chiarenza
Salvatore F
SF
Department of Pediatric Surgery, Saint Bortolo Hospital, Vicenza, Italy. fabio.chiarenza@libero.it
D'Agostino
Sergio
S
Scarpa
Mariagrazia
MG
Fabbro
Mariangelica
M
Costa
Lorenzo
L
Musi
Luciano
L
D000293:Adolescent; D002648:Child; D004396:Coloring Agents; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging*; D008220:Lymphography / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care; D012086:Reoperation; D012394:Rosaniline Dyes; D012720:Severity of Illness Index; D006848:Testicular Hydrocele / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control* / Q000601:surgery; D016896:Treatment Outcome; D014646:Varicocele / Q000000981:diagnostic imaging / Q000601:surgery*
D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue