title: Microsurgical varicocelectomy with transfixing of the difficult-to-isolate periarterial vein using microsutures.
abstract: OBJECTIVE
  To address difficulty in isolating the adhered periarterial vein in microsurgical subinguinal varicocelectomy, we introduced the transfixing microsuture method as well as to evaluate the impact of this technical modification on the surgical success of varicocele repair.
  
  
  METHODS
  We retrospectively evaluated 4 patients with a mean age of 31.5 years who underwent subinguinal varicocelectomy with transfixion of the difficult-to-isolate periarterial vein (a 9-0 transfixing microsuture was placed transversely through the periarterial vein as near to the adjacent border between the testicular artery and adherent vein as possible; then, it was knotted to nick or completely ligate the lumen.) The incidence of recurrence or persistence, postoperative hydrocele formation, sperm improvement, and symptom release was analyzed.
  
  
  RESULTS
  In 4 cases, the periarterial vein transfixing procedures were performed with a mean follow-up of 6 months. No postoperative recurrence or hydrocele was identified postoperatively. One patient reported no symptom improvement, but there was significant improvement in the symptoms and/or semen parameters in the other 3 patients. Postoperative ultrasonography evaluation revealed that there was no postoperative varicocele recurrence or persistence, no hydrocele formation, and no testicular atrophy.
  
  
  CONCLUSIONS
  When the adhered periarterial vein is difficult to isolate and ligate, transfixing the vein with a microsuture in microsurgical subinguinal varicocelectomy is a viable compromise that reduces the incidence of postoperative recurrence or persistence without serious complications.
authors.affiliation: Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. Electronic address: peter.yan.zhang@hotmail.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xiaojian
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Shitao
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008866:Microsurgery; D012008:Recurrence; D012189:Retrospective Studies; D055101:Semen Analysis; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation; D013537:Sutures; D017211:Treatment Failure; D014463:Ultrasonography; D014646:Varicocele / Q000000981:diagnostic imaging / Q000601:surgery*; D014680:Veins / Q000601:surgery*; D055815:Young Adult