title: Long term outcomes of lymphatic sparing laparoscopic varicocelectomy.
abstract: OBJECTIVE
  To assess the long-term occurrence of hydroceles and varicocele recurrence in patients receiving lymphatic sparing laparoscopic varicocelectomy (LSLV) compared to those receiving plain laparoscopic varicocelectomy (PLV), and also to assess the growth of testicular volume postoperatively.
  
  
  METHODS
  We employed a standard three-trocar configuration. The spermatic vessels were identified in the retroperitoneum above the internal inguinal ring. Lymphatics were dissected free from the spermatic artery and veins based on laparoscopic appearance. The spermatic artery and veins were divided between plastic locking clips. We performed a retrospective chart review of all pediatric patients who underwent laparoscopic varicocelectomy between June 2003 and January 2009.
  
  
  RESULTS
  Of a total of 97 patients, 67 underwent LSLV with mean follow-up of 45.8 ± 20.7 months and 30 underwent PLV with mean follow-up of 40.8 ± 25.3 months (p = 15). There was a 4.5% hydrocele rate in the LSLV group compared to 43.3% in the PLV group. Of the patients who underwent a PLV and subsequently developed a hydrocele, 31% (n = 4) required a hydrocelectomy, vs none of those who developed a hydrocele after LSLV. Varicocele rate was 6% in the LSLV group vs 3.3% in the PLV group. However, when the artery was not preserved, the probability of recurrence in the LSLV group was 1.3%. Time to hydrocele formation was 16 months in the LSLV group vs 37 months in the PLV group. There was catch-up testicular growth in both groups.
  
  
  CONCLUSIONS
  There appears to be increased risk of need for a hydrocelectomy after a PLV as compared to LSLV. Performing a lymphatic sparing, non-artery preserving, laparoscopic varicocelectomy has success and complication rates comparable with those of subinguinal microsurgical varicocelectomy. There appears to be excellent catch-up testicular growth with either laparoscopic varicocelectomy technique.
authors.affiliation: Section of Pediatric Urology, New York Medical College, Valhalla, NY, USA.
authors.forename: Emad
authors.initials: E
authors.lastname: Rizkala
authors.forename: Andrew
authors.initials: A
authors.lastname: Fishman
authors.forename: Jordan
authors.initials: J
authors.lastname: Gitlin
authors.forename: Paul
authors.initials: P
authors.lastname: Zelkovic
authors.forename: Israel
authors.initials: I
authors.lastname: Franco
mesh_terms: D000293:Adolescent; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods*; D042601:Lymphatic Vessels / Q000601:surgery*; D008297:Male; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012008:Recurrence; D013085:Spermatic Cord / Q000601:surgery; D006848:Testicular Hydrocele / Q000517:prevention & control; D013737:Testis / Q000601:surgery; D013997:Time Factors; D013519:Urogenital Surgical Procedures / Q000379:methods*; D014646:Varicocele / Q000601:surgery*