Electrocoagulation versus clips in laparoscopic varicocelectomy in boys.

INTRODUCTION

Varicocele occurs in about 15% of adolescents, but it is hardly ever noticed in children under 10 years old. Surgical treatment in adolescents is still controversial.

OBJECTIVES

The aim of this work was to assess the outcome of laparoscopic varicoelectomy by using electrocoagulation versus clips.

MATERIALS AND

METHODS

In the Pediatric Surgery and Urology Departments of the Medical University of Wroclaw, 139 boys with varicocele were operated on by using laparoscopy between 1995 and 2007. In total, 68 (49%) patients appeared for the control ultrasound after the surgery, and only those patients were included in this study. The spermatic vessels (both the artery and the vein) were trans-sected by monopolar diatermy (38 patients; 55.8%) or clips (29 patients; 42%). The spermatic Artery was saved in 5 cases, which have been operated on by using diatermy and in 3 by using clips. The follow-up was from 0.5 to 7 years (mean, 2.7 years).

RESULTS

Among 68 patients from the control group of persistent varicocele with grade II and grade III (Dubin-Amelaar classification) were recognized in 5 (7.3%) boys. In the group of boys, who have been operated on by using diatermy, persistent varicocele was noticed in 10.5% (4), while in those who have been operated on by using clips, the persistent varicocele was recognized only in 3.4% (1). Varicocele with grade I, not demanding a second operation, was recognized in 9 boys (14.7%). The most often found complication was hydrocele. It was recognized in 23.7% (9) boys operated on by using diatermy and in 13.8% (4) boys operated on by using clips.

CONCLUSIONS

Varicocelectomy using clips gives much less complications then the electrocoagulation and should be firstly chosen.