Reactive hydrocele after laparoscopic Palomo varicocele ligation in pediatrics.
OBJECTIVE
To evaluate the incidence of hydrocele following laparoscopic Palomo varicocele ligation in pediatric and adolescents in our institution.


METHODS
Between 1997 and 2009, 180 boys diagnosed as having varicocele who underwent Palomo laparoscopic ligation were evaluated retrospectively. Outcome variables recorded for analysis were age at presentation, symptoms, varicocele grade (Dubin-Amelar classification), testicular atrophy, length of hospital stay, perioperative complications, recurrence and hydrocele formation after surgery. Mean follow up was 5.8 years (6 months- 9 years).


RESULTS
Age at diagnosis ranged between 9 and 19 years. Mean age at operation was 14.1 ± 1.8 years. There were 177 left-side varicoceles (98%) and four cases were bilateral. Testicular atrophy was noted in 45. Mean operative time was 38 min. The last 63 surgeries were performed on a two-trocar basis with Ligasure vascular sealing device and operative time decreased significantly to 22 min. Median hospital stay was 31h. Twenty-three patients developed hydrocele (13%); 11 of these underwent Winkelman-Lord's hydrocelectomy at least 1 year after Palomo (9% of total). Of the remaining 12, two resolved spontaneously and 10 were stable at mean 4-year follow up.


CONCLUSIONS
Laparoscopic Palomo procedure is a safe successful method to correct varicoceles in pediatric and adolescent males. Reactive hydrocele formation following laparoscopic varicocelectomy is a worrisome problem particularly in cases with longer follow-up.
Méndez-Gallart
Roberto
R
Pediatric Surgery Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, La Coruña, Spain. roberto.mendez.gallart@sergas.es
Bautista Casasnovas
Adolfo
A
Estévez Martínez
Elina
E
Rodríguez-Barca
Pablo
P
Taboada Santomil
Pedro
P
Armas
Azucena
A
Pradillos
Jose
J
Rivera
Lizet
L
Varela Cives
Ramiro
R
D000293:Adolescent; D002648:Child; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008026:Ligation; D008297:Male; D012189:Retrospective Studies; D006848:Testicular Hydrocele / Q000209:etiology*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods; D014646:Varicocele / Q000601:surgery*; D055815:Young Adult