Laparoscopic Palomo varicocele surgery: Lessons learned after 10 years’ follow up of 156 consecutive pediatric patients

ObjectivesTo evaluate our experience using laparoscopic Palomo varicocele ligation in a population under 18 years, and confirm the factors involved in postoperative hydrocele formation.Patients and methodsBetween 1997 and 2007, 156 boys diagnosed as having varicocele were evaluated retrospectively. Outcome variables recorded for analysis were age at presentation, symptoms, varicocele grade (Dubin–Amelar classification), testicular atrophy, length of hospital stay, perioperative complications, recurrence and hydrocele formation after surgery. Mean follow up was 5.6 years (6 months– 9 years).ResultsAge at diagnosis ranged between 9 and 18 years. Mean age at operation was 14.1 ± 1.8 years. There were 153 left-side varicoceles (98%) and three cases were bilateral. All patients had grade II or III varicocele (38%/62%) and testicular atrophy was noted in 43.8%; 8.1% mentioned testicular pain at diagnosis. All boys underwent Palomo laparoscopic ligation of the spermatic vessels. Mean operative time was 38 min (25–82 min). The last 51 surgeries were performed on a two-trocar basis with Ligasure^® vascular sealing device and operative time decreased significantly to 22 min (16–32 min) (P < 0.05). Median hospital stay was 31 ± 8 h. Conversion rate was 1.28%. Twenty-one patients developed hydrocele (13.5%); 11 of these underwent Winkelman–Lord's hydrocelectomy at least 1 year after Palomo (9% of total). Of the remaining 10, two resolved spontaneously and eight were stable at mean 4-year follow up.ConclusionsLaparoscopic Palomo varicocele surgery for pediatric patients is a safe and effective procedure. Recurrence and complication rates are similar to those reported with open surgery.