LAPAROSCOPIC SELECTIVE VENOUS DISCONNECTION FOR VARICOCELE | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 20, Issue 2, April 2001, Page 568-578 PDF (1.25 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2001.376385 | ||||
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| Author | ||||
| Mohamed El-Sherif El-Sarky* | ||||
| Department of Surgery, Faculty of Medicine, Cairo University, Egypt | ||||
| Abstract | ||||
| The incidence of recurrence after surgery for varicocele ranges from 5 to 45%. The known reasons for this high recurrence are: 1) Development of collaterals in the pre-existing communicators of testicular vein (testiculo-ureteric, testiculo-colic, testiculo-renal, testiculo-testicular and others), 2) Persistence and progression of refluxing unattended venous drainage routes, e.g. external spermatic vein, and 3) Inadequate procedure (incomplete interruption or missing accessory or aberrant testicular vein). Laparoscopy provides an ideal access to treat varicocele due to clear visualization of most of the involved venous systems (internal spermatic, external spermatic, deferential and others). The problem of recurrence is still observed with the conventional laparoscopic procedure for varicocele. Attempts at improving the current approach are thus invited. In this work, a new laparoscopic approach for varicocele is described and its preliminary results are presented. The technique was designed to address known causes of recurrence of varicocele. It is based on the following principles: 1) Doppler guided identification of the individual veins involved in the pathology (reflux), 2) performing venous disconnection in place of simple interruption (by excising a long segment of internal spermatic vein to widen the pressure front, and ablating the veins within an area which extends across the course of the vein to eliminate communicator veins), and 3) Intraoperative assessment of completion of the procedure by Doppler testing for reflux. Early results in 14 patients were encouraging. No Duplex-detected recurrence was observed during a follow-up period of 3 to 11 months. Conception occurred in 2 couples and 11 patients showed significant improvement in the quality of semen. | ||||
| Keywords | ||||
| Laparoscopic varicocele; selective disconnection; intraoperative Doppler | ||||
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