title: Laparoscopic surgery of deferential reflux in pediatric and adolescent varicocele.
abstract: BACKGROUND
  This study aimed to assess whether deferential reflux in pediatric and adolescent varicocele can be successfully treated laparoscopically.
  
  
  METHODS
  Since 2001 at our institution, 148 boys were evaluated for a left varicocele. Preoperatively,all the patients underwent ultrasound scan assessment of testicular volume and color-Doppler US (CDUS)to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. Boys with ISV reflux were treated by laparoscopic transperitoneal Palomo; boys with isolated deferential reflux or associated to ISV reflux were laparoscopically managed adding to the former procedure, coagulation or clipping of refluxing deferential veins.
  
  
  RESULTS
  Reflux in both the ISV and the deferential vein was observed in 21 (14.1%) out 148 boys with varicocele.Only one case (0.6%) of varicocele was caused by an isolated deferential reflux. No reflux in the cremasteric vein was observed. After a median follow up period of 2 years (range, 6 months-5 years), none of our patients with deferential reflux experienced varicocele recurrence either clinically or according to CDUS scanning.No testicular atrophy was observed.
  
  
  CONCLUSIONS
  Our diagnostic approach is a rigorous standard for identifying all the venous systems concurring with the varicocele. Our proposed technique with laparoscopic interruption or coagulation of deferential veins when proved by CDUS to be refluxing may allow successful treatment for most varicoceles. This method allows reduction in recurrence of varicocele due to a missed deferential reflux.
authors.affiliation: Department of Mother and Child Care, Università di Palermo, Palermo, Italy. mcimador@unipa.it
authors.forename: Marcello
authors.initials: M
authors.lastname: Cimador
authors.forename: Maria R
authors.initials: MR
authors.lastname: Di Pace
authors.forename: Maria
authors.initials: M
authors.lastname: Sergio
authors.forename: Pieralba
authors.initials: P
authors.lastname: Catalano
authors.forename: Marco
authors.initials: M
authors.lastname: Castagnetti
authors.forename: Enrico
authors.initials: E
authors.lastname: De Grazia
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D014463:Ultrasonography; D014646:Varicocele / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014649:Vas Deferens / Q000503:physiopathology*