Laparoscopic ligation of varicoceles: an anatomically superior operation.

Since December 1991, 25 consecutive symptomatic male patients with 26 varicoceles were treated by laparoscopic ligation of internal spermatic veins under general anaesthesia. Twenty-one patients had either scrotal discomfort or painful swelling and four patients presented with infertility. The mean follow-up period is 5 months (range 3 weeks to 9 months). The procedure has provided a satisfactory outcome in 19 out of 21 patients (90.5%) with scrotal symptoms. Of the four patients presenting with infertility due to oligospermia, three had significantly elevated sperm counts at 3 months which resulted in one pregnancy. So far there has been no recurrence of the varicocele. The main potential advantage of the laparoscopic approach is better visualisation of the anatomy, especially the testicular artery and the collateral venous circulation at the level of the internal inguinal ring. In addition to being less invasive with implied benefits, the endoscopic procedure has enabled identification of multiple veins in 22 out of 26 (84.6%) varicoceles in our series.