Complications of pediatric laparoscopic varicocelectomy: A single center experience
David W. Sobel, MD1, Gerald C. Mingin, MD2.
1University of Vermont, Burlington, VT, USA, 2University of Vermont / Vermont Children's Hospital, Burlington, VT, USA.
BACKGROUND: Laparoscopic varicocelectomy is performed in pediatric patients presenting with testicular hypotrophy and less commonly pain. Postoperative complications include recurrent varicocele and hydrocele formation. There are few reports in the literature describing pain resolution including prepubertal boys. In previous studies, up to 34% of patients undergoing laparoscopic varicocelectomy developed a hydrocele postoperatively. The technique of ligation but not division of the spermatic vessels practiced at our institution has led to lower complication rates in comparison to the published data. The purpose of this study is to report our complication rates using the described technique, as well as our rate of pain resolution post-surgery.
METHODS: A retrospective chart review was conducted retrieving all operative records for pediatric patients undergoing laparoscopic varicocelectomy from June 1, 2007 to May 1, 2017. A total of 52 patients were reviewed. Preoperative examination, varicocele side and grade, indication for surgery, postoperative resolution of pain and complications were recorded.
RESULTS: The mean age at time of surgery was 14 years old (range 11-22). 51/52 (98.1%) patients underwent left sided varicocelectomy. One patient underwent bilateral varicocelectomy. A grade three (easily visible) varicocele was demonstrated in 50/52 patients and grade two (easily palpable but not visible) in two patients. Scrotal/testicular pain was the primary indication for surgery in 15/52 (28.8%) patients. For 33/52 (63.5%) patients the primary indication was testicular hypotrophy. Four patients underwent the procedure for both pain and hypotrophy. The grade two varicoceles were both repaired for size differential. Postoperatively, one patient (1.9%) developed a hydrocele which required surgical correction. A recurrent varicocele developed in one patient (1.9%) who elected to have a subinguinal varicocelectomy. Of the 19 procedures where pain or both pain and hypotrophy were the primary indication we had follow-up on 15 patients (median follow up of 5.7 months). 12 (80%) patients had complete pain resolution while two (13.3%) patients had persistent pain. Of note, persistent pain was seen only in the patients with recurrent varicocele and postoperative hydrocele. CONCLUSIONS: We report that a lower rate of postoperative hydrocele formation occurs with laparoscopic varicocelectomy which can be achieved with ligation but not division of the spermatic vessels. We attribute the low rate of hydrocele formation compared to other studies to the potential preservation of the lymphatic channels along the spermatic cord. The rate of varicocele recurrence (1.9%) was equivalent to previously published results. Importantly, we demonstrated a high rate of pain resolution in the absence of postoperative hydrocele formation and/or recurrence of the varicocele. To our knowledge this is the largest study in the literature looking at rates of pain resolution and post-operative complications in the youngest patients to date.
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