Laparoscopic varicocele ligation in children and adolescents using isosulphan blue: a prospective randomized trial.
OBJECTIVE
To evaluate, in a randomized prospective trial in children and adolescents, the feasibility of isosulphan blue-based lymphatic vessel preservation during laparoscopic varicocelectomy and its impact on the complication rate, as the operative management of varicoceles remains controversial.


METHODS
In all, 50 consecutive patients were randomly assigned to two laparoscopic varicocelectomy groups. The indications for surgery included scrotal pain and a difference in testicular size, as well as severe cosmetic impairment. All the patients had a laparoscopic varicocelectomy using three ports. Patients in group A had standard laparoscopy, while those in group B had additional isosulphan blue administered. After surgery, the patients were assessed at 3, 6 and 12 months for varicocele recurrence, hydrocele formation, atrophy, pain or other complications.


RESULTS
There were no intraoperative complications or conversions to open surgery. There were no adverse reactions, scrotal haematomas or atrophy. At 3 months after surgery, the incidence of hydrocele in group A was 20% whereas in group B no hydroceles were detected (P = 0.025); at 6 months the 20% still had hydroceles. One patient in each group had varicocele recurrence associated with persistent pain. In two patients in group B, blue pigmentation of the left hemiscrotum persisted at the 3-month follow-up but resolved by 6 months.


CONCLUSIONS
Laparoscopic repair of varicoceles using isosulphan blue helps to identify and preserve the lymphatic drainage. It prevents secondary hydrocele formation, the most common complication, with no supplementary risk to the patient. Also, testicular oedema causing impaired spermatogenesis can be avoided.
Schwentner
Christian
C
Department of Paediatric Urology, Medical University, Innsbruck, Austria. christian.schwentner@uibk.ac.at
Radmayr
Christian
C
Lunacek
Andreas
A
Gozzi
Christian
C
Pinggera
Germar M
GM
Neururer
Richard
R
Peschel
Reinhard
R
Bartsch
Georg
G
Oswald
Josef
J
D000293:Adolescent; D000328:Adult; D002648:Child; D003287:Contrast Media; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation / Q000379:methods; D008297:Male; D011446:Prospective Studies; D012394:Rosaniline Dyes; D055502:Secondary Prevention; D006848:Testicular Hydrocele / Q000517:prevention & control*; D016896:Treatment Outcome; D014646:Varicocele / Q000601:surgery*
D003287:Contrast Media; D012394:Rosaniline Dyes; C025484:iso-sulfan blue