title: Changing concepts in microsurgical pediatric varicocelectomy: is retroperitoneal approach better than subinguinal one?
abstract: OBJECTIVE
  To compare and to assess two different microsurgical "lymphatic-sparing" techniques (subinguinal/inguinal vs. retroperitoneal) used for the treatment of a pediatric and adolescent varicocele in terms of success rate, complications and mean operative time.
  
  
  METHODS
  A retrospective study included 54 consecutive patients affected by a varicocele and treated with a microsurgical (loupes--operating microscope) magnification. Thirty-four out of 54 (group 1) underwent subinguinal ligation with the help of loupes magnification (× 3); 20 out of 54 (group 2) underwent retroperitoneal (Palomo like) ligation with preservation of lymphatics and with the help of an operating microscope (× 6 to 10). The two groups were homogeneous in terms of mean age, clinical and color Doppler ultrasound grade of disease. Pre- and post-operative testicular volume was measured in all cases. All the procedures were performed under general anesthesia and in an outpatient basis.
  
  
  RESULTS
  Mean post-operative follow-up time was 23.6 months. In group 1 we observed 3 (8.8%) early complications (wound's infection, transient hydrocele), 2 (5.8%) recurrences and 1 (2.9%) major complication (atrophy of the testis). Mean operative time was 45 +/- 6 min. In group 2 we did not observe complications and/or varicocele recurrence and mean operative time was 38 +/- 7 min. Comparison of mean operative time between the two groups resulted statistically significant differences (P < .05) such as the difference in testicular "catch-up" growth volume between pre- and post-operative evaluations.
  
  
  CONCLUSIONS
  Retroperitoneal microsurgical "lymphatic-sparing" varicocelectomy is safe and effective method. In our experience, it is preferable, in the pediatric and adolescent patient, to the subinguinal/inguinal approach in terms of success rate, complications and operative time duration.&nbsp;
authors.affiliation: Department of Surgery and Transplantation, Center Bambino Gesù Children's Research Hospital, Via Torre di Palidoro 00050, Palidoro, Rome, Italy.massimiliano.silveri@gmail.com.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Silveri
authors.forename: Francesca
authors.initials: F
authors.lastname: Bassani
authors.forename: Ottavio
authors.initials: O
authors.lastname: Adorisio
mesh_terms: D000293:Adolescent; D001284:Atrophy / Q000209:etiology; D002648:Child; D006801:Humans; D042601:Lymphatic Vessels / Q000601:surgery; D008297:Male; D008866:Microsurgery; D061646:Operative Time; D059351:Organ Sparing Treatments; D012008:Recurrence; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D006848:Testicular Hydrocele / Q000209:etiology; D013737:Testis / Q000473:pathology*; D014463:Ultrasonography; D013519:Urogenital Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014646:Varicocele / Q000000981:diagnostic imaging / Q000601:surgery*