title: Laparoscopic lymphatic sparing varicocelectomy in adolescents.
abstract: OBJECTIVE
  Laparoscopic varicocelectomy is similar to an open Palomo repair. Both procedures involve en masse ligation of the internal spermatic cord, and both are associated with a 1% to 3% incidence of recurrence and up to a 30% incidence of hydroceles. We sought to determine the impact of lymphatic preservation on hydrocele formation and the success of varicocelectomy.
  
  
  METHODS
  We retrospectively evaluated 191 patients with a mean age of 15.2 years who underwent laparoscopic varicocelectomy and at least 6 months of followup. Patients were divided into 2 groups-those who had undergone a lymphatic sparing procedure and those who had undergone a nonlymphatic sparing technique. The incidence of recurrence/persistence, postoperative hydrocele formation and postoperative hydrocele requiring surgery or aspiration was analyzed.
  
  
  RESULTS
  A total of 174 laparoscopic lymphatic sparing procedures (132 patients, 42 bilateral) and 88 nonlymphatic sparing repairs (59 patients, 29 bilateral) were performed, with a mean followup of 26.1 months. Lymphatic sparing surgery was associated with a decreased incidence of postoperative hydrocele (3.4% vs 11.4%, p = 0.025). There was no significant difference in incidence of persistent or recurrent varicocele requiring reoperation following lymphatic sparing (5 sides, 2.9%) vs nonlymphatic sparing (4 sides, 4.5%) varicocelectomy (p = 0.736).
  
  
  CONCLUSIONS
  Laparoscopic lymphatic sparing varicocelectomy is preferable to an open or laparoscopic Palomo repair that does not preserve the lymphatics. It has a significantly lower incidence of postoperative hydroceles, especially those requiring surgical intervention, and still maintains a low incidence of persistence/recurrence. The procedure is especially advantageous for bilateral varicocelectomy.
authors.affiliation: Division of Pediatric Urology, Department of Urology, Columbia University, College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York, USA. kglassberg@aol.com
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Glassberg
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Poon
authors.forename: Carl K
authors.initials: CK
authors.lastname: Gjertson
authors.forename: G Joel
authors.initials: GJ
authors.lastname: DeCastro
authors.forename: Rosalia
authors.initials: R
authors.lastname: Misseri
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D010535:Laparoscopy; D008198:Lymph Nodes; D008297:Male; D012189:Retrospective Studies; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014646:Varicocele / Q000601:surgery*