Successful outcomes in adolescent varicocele treatment with high-level laparoscopic varicocelectomy

Purpose: In this study, we aimed to compare the effects of testicular vein ligation level on complications encoun-tered; i.e. high-level ligation cranial to the linea terminalis vs ligation caudal to the linea terminalis. Methods: A total of 47 unilateral adolescent patients, treated with laparoscopic varicocelectomy between January 2004 and December 2017, were reviewed retrospectively. Patients were divided into two groups in terms of li-gation level: caudal to the linea terminalis as group 1 and cranial to the linea terminalis as group 2. Symptoms, varicocele grades, preoperative testicular growth arrest, operative method, hydrocele formation, postoperative recurrence and testicular catch-up growth were recorded. Results: The mean operation time was 38.6 +/- 10.2 min (34-53 min) in group 1 and was 33.6 +/- 6.4 min (29-42 min) in group 2. Single hydrocele occurred in the laparoscopic nonselective varicocelectomy in group 1 (4.5%) and was successfully treated with open hydrocelectomy. Single varicocele recurrence was observed in the laparoscopic selective varicocelectomy in group 1 (4.5%) and treated with laparoscopic nonselective varicocelectomy cranial to the linea terminalis. Conclusions: The high-level ligation of the spermatic veins cranial to the linea terminalis during laparoscopic varicocelectomy, independent of the technique applied, may contribute to reasonable low hydrocele and recur-rence rates. (c) 2019 Elsevier Inc. All rights reserved.