The value and the advantages of videosurgery in the management of pediatric varicoceles

Objective. The aim of this article was to evaluate the results and advantages of videosurgical varicocelectomy in a pediatric population. Methods. One hundred-one children underwent videosurgical treatment of varicocele. Seventy-five out of 101 children were treated laparoscopically: 10 (13.4%) underwent ligation of the spermatic veins, and 65 (86.6%) underwent ligation of the testicular veins and artery. In 26/101 children, the procedure was performed in retroperitoneoscopy: 5 underwent the Ivanissevich procedure and 21 the Palomo procedure. In 6 cases, operated on using laparoscopy, an additional procedure was applied during the same intervention. Results. Average operating time was 30 minutes, with an hospitalisation of about 24- hours. At medium follow-up of 24-months (12-months-4 yrs) there were 10 (9.9%) left hydrocele in children operated on with the Palomo technique. There were 3 recurrences of varicocele in our series: 1 case (6.6%) after the Ivanissevich procedure and 2 (2.3%) in patients treated with Palomo’s technique. Conclusions. Videosurgery seems to have 3 important advantages over the other procedures adopted to treat varicocele, above all, the mini-invasiveness and the precision of the intervention. Moreover it allows to treat during the same anesthesia other intra-abdominal pathologies as happened to 6 patients in our series. The third one is that in laparoscopy it is possible to treat a bilateral varicocele during the same anaesthesia without additional scars or additional operating time. As to the technique to be applied, there is statistically not significant difference (p=0.4801) between the two procedures adopted (Palomo and Ivanissevich), even if the Palomo procedure has a rather relevant incidence of post-operative hydrocele.