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  • Comparison between Mass Ligation of Testicular Vessels versus Testicular Artery Sparing during Laparoscopic Bilateral Varicocelectomy
    Wadie Boshra MD, MRCS, Mohammed Attia Elsayed MD, Ahmed S. M. Omar MD.
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  • Comparison between Mass Ligation of Testicular Vessels versus Testicular Artery Sparing during Laparoscopic Bilateral Varicocelectomy

    Wadie Boshra MD, MRCS, Mohammed Attia Elsayed MD, Ahmed S. M. Omar MD.
    Department of General Surgery, Ain Shams University, Cairo, Egypt.

    Background: Varicocele is an abnormal dilatation of the cremasteric venous plexus that may present with scrotal pain or subfertility. Laparoscopic approach for bilateral varicocelectomy is safe and cost effective. There is still a debate regarding the necessity of sparing the testicular artery during high varicocelectomy. Aim: the aim was to evaluate and compare artery sparing and mass ligation of testicular vessels during laparoscopic varicocelectomy. Patients & Methods: From April 2015 to January 2019, 37 patients underwent laparoscopic bilateral varicocelectomy at Ain shams university hospitals and were divided into 2 groups: Group A (19); mass ligation and Group B (18); artery sparing. Both groups were compared as regards the complications (hydrocele and recurrence) and testicular functions: average testis size, semen sperm count and male hormones (S. Testosterone and FSH). All the patients were followed up for one year. Results: The mean operative time in group A was 51.84 ± 8.08 min, in group B patients was 72 ± 13.5min (P:0.001). Early clinical hydrocele occurred in 5.3% in group A and in 22.2% in group B (P:0.18). Delayed radiological hydrocele occurred in 31.6% in group A and in 72.2% in group B (P:0.013). Subclinical recurrence occurred only in 11.1% in group B (P: 0.23). Average testicular size, semen sperm count and S. testosterone levels improved significantly in each group but when comparing both groups all results were insignificant. Conclusion: Based on the results of this study, given the increased potential for recurrence with the significant difference in operation time, no evidence was found to support the necessity of sparing the testicular artery when performing laparoscopic bilateral varicocelectomy; however, larger sized studies are required to confirm these results. Key words: Varicocelectomy, laparoscopic, mass ligation, artery sparing, hydrocele, recurrence, testicular functions.