Varicocele vein ligation in 565 patients under local anesthesia: a long-term review of technique, results and complications in light of proposed management by laparoscopy.

Several recent reports have suggested that laparoscopic internal spermatic vein ligation provides a simpler, less debilitating and more cost efficient method of varicocele ligation than conventional surgical techniques. We analyzed the results of open varicocele ligation using local anesthesia in 565 patients for 10 years. All surgery was performed in the outpatient setting using 0.5% lidocaine. In most patients 50 to 200 mcg. fentanyl or 3 to 7 mg. midazolam were used for intravenous sedation. The average operating time, including the administration of anesthesia, was 39 minutes for unilateral and 71 minutes for bilateral procedures. All patients returned to light duty work in 24 to 48 hours and full strenuous physical activity within 1 week. The only complications encountered were 2 wound hematomas (0.3%), 4 minor wound separations (0.7%) and 41 hydroceles (7.3%). Semen improvement and pregnancy rates were similar to those reported in prior series. This study demonstrates that varicocele vein ligation can be done rapidly, efficiently and safely using local anesthesia with time of recovery and return to work comparable to those reported for laparoscopic techniques.