Varicocelectomy via inguinal or sub inguinal route

The preferred routes of surgical access are inguinal or sub-inguinal, which allow a better exposure of the vascular structures to be identified (spermatic artery, veins and lymphatic vessels), and are associated with a lower risk of complications.

In the traditional inguinal varicocelectomy, an incision of about 2 cm is made along the inguinal canal, and the structures of the spermatic cord, i.e. venous, arterial and lymphatic vessels of the testicle and the vas deferens, are identified and isolated. Then the dilated testicular veins are identified, ligated and, if necessary, dissected. Subsequently, the funiculus is repositioned on its bed and the planes are carefully sutured to the skin, where a small scar remains.
In the subinguinal approach, the method of ligation of the testicular veins is the same, while the skin incision is conducted just below the level of the external inguinal ring, thus avoiding the opening of the external oblique muscle.

For a more precise identification of anatomical structures, specific surgical glasses are used that allow optical magnification. The microsurgical technique is the one that today presents the best success rates and the lowest incidence of complications, such as hydrocele (peritesticular liquid collection due to lymphatic obstruction after surgery), lesion of the spermatic artery (0.1% in our case history) and recurrence of varicocele (5% in our case history). There was an improvement in the spermiogram in 30-80% of patients, with pregnancy rates between 20 and 60%. The operation, if the clinical conditions of the patient allow it, is performed under loco-regional (spinal) anesthesia, lasts about 45 minutes and is conducted in day surgery.