Totally extraperitoneal (TEP) bilateral varicocelectomy (BLV) – a comparative study of collateral venous channels in left and right varicocele and their accessibility by TEP route

Objective of Study :Results of bilateral varicocelectomy are sometimes a concern due to recurrence, hydrocele and no improvement in semen parameters specially when done for male infertility. Both Retroperitoneoscopic and Microvascular subinguinal approaches have these drawbacks. An anterior Extraperitoneal approach presented by us earlier enables visualization of venous collaterals from high retroperitoneum (HRP) till subinguinal (SI) level. We present findings on these collaterals and their variance on right and left side.
Methods and Procedures :Prospective data collection on subsequent cases for properly evaluated candidates for bilateral varicocelectomy. TEP approach as used for inguinal hernia was used to search, ligate and divide any venous channels in spermatic pedicle from HRP to SI levels. Cord could be pulled out of inguinal canal. Testicular artery and fat posterior to vessels ( to preserve Lymphatics) were preserved. No energy sources were used. All surgeries were day care. Recurrence, hydroceles and semen were evaluated at , 3 months, 6 months and 1 year.
Results : 20 BLVs were done. There was no difficulty or conversion, need to use energy sources or loss in follow up. Collaterals were found universally in left varicocele usually from veins of vas or pelvis. There was no recurrence, unresolved hydrocele or absence of improvement in semen parameters. Distribution of collaterals is as shown-
Conclusions : A thorough search for collaterals from HRP to SI level improves results in bilateral varicocelectomy. TEP approach provides safe & easy surgical access from HRP to SI levels on both sides through a single anterior route.

Session: Poster

Program Number: P360

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