Blue patent lymphography prevents hydrocele after laparoscopic varicocelectomy: 10 years of experience.
OBJECTIVE
Laparoscopic varicocelectomy according to the Palomo technique is the most common procedure adopted in children with testicular varicocele. This procedure involves the ligation of the internal spermatic cord and is associated with a 3%-5% incidence of recurrence and up to 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 396 patients with a mean age of 13.2 years who underwent laparoscopic varicocelectomy. Patients were divided into two groups: those who underwent a lymphatic-sparing (LS) procedure using isosulfan blue scrotal intra-dartoic injection and those who underwent a non-LS (NLS) technique. The incidences of recurrence/persistence and postoperative hydrocele formation requiring surgery or aspiration were analyzed statistically using the chi-squared test.


RESULTS
Of 396 patients, 244 received a laparoscopic LS procedure, and 152 received an NLS operation. The LS patients in whom the lymphatic vessels were not identified (26/244 [10.6%]) were considered NLS repairs. The follow-up was at least 12 months. LS surgery (218 patients) was associated with a decreased incidence of postoperative hydrocele (0/218 [0%] versus 18/178 [10.1%]; chi-squared test=25.84, difference statistically significant). There was no significant difference in incidence of persistent or recurrent varicocele requiring reoperation following the initial procedure (5/218 [2.2%] versus 5/178 [2.8%]; chi-squared test=0.41, difference statistically not significant).


CONCLUSIONS
Laparoscopic LS varicocelectomy using isosulfan blue is preferable to laparoscopic Palomo repair that does not preserve the lymphatics. It has a significantly lower incidence of postoperative hydroceles and still maintains a low incidence of persistence/recurrence.
Department of Pediatric Surgery, Saint Bortolo Hospital, Vicenza, Italy. fabio.chiarenza@libero.it
Salvatore Fabio
SF
Chiarenza
Ida
I
Giurin
Lorenzo
L
Costa
Francesca
F
Alicchio
Alessandro
A
Carabaich
Teresa
T
De Pascale
Alessandro
A
Settimi
Ciro
C
Esposito
D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D004396:Coloring Agents; D006801:Humans; D015994:Incidence; D008026:Ligation; D008220:Lymphography / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D006848:Testicular Hydrocele / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue