Is laparoscopy a worthy method to treat varicocele? Comparison between 160 cases of two-port laparoscopic and 120 cases of open inguinal spermatic vein ligation.

Because it is still a puzzling debate whether ligation of a unilateral varicose spermatic vein is worth performing by laparoscopy, even with the two-port technique, we conducted a study in which 280 patients with palpable left varicoceles were treated with spermatic vein ligation either by open surgery (120 patients) or by laparoscopy (160 patients). The inclusion criteria were the same for each group, and the two groups were homogeneous in preoperative clinical features and patient characteristics. The clinical outcomes were compared 6 months after surgery, and the costs of each treatment were analyzed. The procedures showed the same effectiveness and intraoperative safety. Open surgery scored a shorter operating time, whereas hospitalization was significantly shorter in the laparoscopic group. Postoperative complications occurred more frequently in the open surgery than in the laparoscopic group (7.5% and 0.6%, respectively). Of the patients treated, 197 were eligible for seminal analysis: 82 and 115 in the open surgery and laparoscopic groups, respectively. Significant improvement in seminal analysis was recorded in both groups, whereas no difference was found between the groups. Laparoscopy costs about 60% more than open surgery. It can thus be concluded that laparoscopy is not a worthy method to treat unilateral varicocele.