title: [Effects and complications of five surgical approaches to the treatment of varicocele: A comparative study].
abstract: OBJECTIVE
  To compare the effects and complications of subinguinal microscopic ligation, laparoscopic transperitoneal varicocelectomy, laparoscopic retroperitoneal varicocelectomy, open retroperitoneal high ligation, and interventional embolotherapy in the treatment of varicocele.
  
  
  METHODS
  We conducted a retrospective study that included 632 varicocele patients treated by subinguinal microscopic ligation (group A, n = 79), laparoscopic transperitoneal varicocelectomy (group B, n = 120), laparoscopic retroperitoneal varicocelectomy (group C, n =137), open retroperitoneal high ligation (group D, n = 283), and interventional embolotherapy (group E, n = 13). We compared the baseline and 3-month postoperative semen parameters, postoperative complications, and pregnancy rate among the five groups of patients.
  
  
  RESULTS
  The operation time was longer in groups A ([2.02 ± 1.25] h) and E ([2.17 ± 1.02] h) than in the other three groups, while the postoperative hospital stay was the shortest in group E ([1.1 ± 0.1] d). Intestinal injury or incision bleeding occurred intraoperatively in 2 cases in group B and 1 case in group E. Postoperative scrotal edema developed in 3.7, 17, 10, and 19% of the patients in groups A, B, C, and D, respectively, but not in group E. The rate of 1-year recurrence was the lowest in group A (1.6%) and highest in group E (22%). Sperm concentration and the percentages of progressively motile sperm and morphologically normal sperm were improved postoperatively in all the patients (P < 0. 05), but there were no statistically significant differences among the five groups either in the above three parameters or in the postoperative pregnancy rate (P > 0. 05).
  
  
  CONCLUSIONS
  In the surgical treatment of varicocele, laparoscopic retroperitoneal approach involves short operation time and few complications, subinguinal microscopic ligation has the advantages of little injury, rapid recovery, and few complications but requires specialized microsurgical techniques, and interventional embolotherapy leaves no incision scar and needs only local anesthesia and 1-day postoperative hospital stay, which is uitable for those with a contraindication to anesthesia.
authors.forename: Yun
authors.initials: Y
authors.lastname: Chen
authors.forename: Zhi-peng
authors.initials: ZP
authors.lastname: Xu
authors.forename: Hai
authors.initials: H
authors.lastname: Chen
authors.forename: Wen
authors.initials: W
authors.lastname: Yu
authors.forename: You-feng
authors.initials: YF
authors.lastname: Han
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhang
authors.forename: Qing-qiang
authors.initials: QQ
authors.lastname: Gao
authors.forename: Yu-tian
authors.initials: YT
authors.lastname: Dai
mesh_terms: D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage; D011247:Pregnancy; D018873:Pregnancy Rate; D012008:Recurrence; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013076:Sperm Count; D013519:Urogenital Surgical Procedures / Q000009:adverse effects; D014646:Varicocele / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods