A COMPARATIVE STUDY OF THE OUTCOME OF HIGH AND LOW LIGATION OF VARICOCELE | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 32, Issue 4, October 2013, Page 304-316 PDF (143.27 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2013.366725 | ||||
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| Authors | ||||
| Emam El-Sayed Ezzat Fakhr1; Hisham Adel Alaa El-Din1; Wafy Fouad Salib1; Afaf Abd El-Alim Mostafa2; Hosam Ahmed Fouad Halim* 3 | ||||
| 1General Surgery Department, Faculty of Medicine, Ain Shams University, Egypt | ||||
| 2Clinical Pathology Department, Faculty of Medicine, Ain Shams University,, Egypt | ||||
| 3General Surgery Department, Student Hospital-Mansoura University, Egypt | ||||
| Abstract | ||||
| Introduction: Varicocele, defined as dilatation of the pampiniform plexus, has long been recognized as a treatable cause of male infertility. Varicocele results in generalized impairment of sperm production, loss of testicular volume as well as enzymatic impairment in the final stage of testosterone biosynthesis. This study aims to compare the outcome of varicocelectomy done by the open retroperitoneal high ligation (modified Palomo), the low ligation (subinguinal) and laparoscopic transperitoneal ligation as regard to: Semen parameter (sperm count, motility and percentage of abnormal sperm forms), serum levels of: Testosterone, FSH, LH and Prolactin and testicular volume measured by ultrasonography. Patients and Methods: Between May 2006 to January 2008 a total of seventy-eight patients were chosen from the outpatient clinic of the Ain Shams University Hospitals to participate in this study. They were referred to surgery as varicoceles with either infertility (40 cases)or chronic scrotal pain (38 cases).All the patients were subjected to complete semen analysis ,blood sampling for hormonal assay (testosterone, FSH, LH and Prolactine)and underwent scrotal dopplex sonography. The 78 patients were randomly divided into three groups: 1 st group: Open high retroperitoneal ligation (35 patients), 2nd group: subinguinal ligation (35 cases) and 3rd group laparoscopic transperitoneal ligation (8 patients). Results: There was significant improvement in all semen parameter after high ligation and subinguinal ligation at 3 and 6 months postoperatively (p value <0.05). The postoperative change of serum level of testosterone was significant after each approach at 3 and 6 months (p value <0.05). On the other hand, serum levels of FSH, LH and Prolactin changed insignificantly after each approach at 3 and 6 months postoperatively (p value>0.05).There was no significant difference in the percentage of change among the different operations as regard to the impact on semen parameters, testicular volume as well as the mean serum hormone levels postoperatively for the infertile group. The open high ligation resulted in significant higher incidence of postoperative hydrocele and postoperative recurrence compared with other two approaches. Summary: Both subinguinal and laparoscopic approaches are more preferable than open high ligation due to the lesser incidence of postoperative complications (hydrocele and recurrence). | ||||
| Keywords | ||||
| Varicocele; Infertility; Semen parameters; Hormone level; Testicular volume; Outcome assessment | ||||
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