Extended vein ligation: a new aspect of the surgical treatment of varicocele.

Conventional varicocelectomy is complicated by a postoperative recurrence rate of 5-20% in patients with varicocele. On the other hand, the exact location and relationship of the internal, external and gubernacular veins, arteries and lymphatics within the inguinoscrotal portion of the spermatic cord have not been well described. The results of detailed intraoperative observations and surgical dissection of the spermatic cord and gubernaculum are presented in 32 patients with clinically palpable varicocele. Following the identification of all veins within and around the spermatic cord and gubernaculum, dilated veins originating from the testis and traversing the gubernaculum were observed in 31% of the patients. External spermatic veins were present in 70% of all spermatic cords evaluated. The majority of patients (> 65%) had more than 3 internal spermatic veins. An average of 3.1 lymphatics per spermatic cord was identified and preserved during dissection of the cord. A solitary testicular artery was observed in 55% of the patients treated. In 3 patients with recurrent varicocele, by using intraoperative venography, we tried to demonstrate the relationship between the gubernacular, external spermatic veins and the plexus pampiniformis. Our results indicate that by giving a precise attention to varicocele anatomy and performing an extended vein ligation, better results together with decreased recurrence rates may be obtained.