Laparoscopic Versus Open Inguinal Ligation of Varicocele: A Study of 60 Cases

Objective: To compare the results of trans-peritoneal laparoscopic varicocelectomy with open inguinal technique in terms of operation time, post-operative pain and analgesic requirement, post-operative complications and hospital stay. Study design: Randomized controlled trial. Place & Duration of study: Department of Urology, Jinnah Postgraduate Medical Center (JPMC) Karachi, from January 2017 to December 2020. Methodology: This prospective study composed of 60 patients diagnosed as primary varicocele clinically or as asymptomatic on Doppler U/S. They were divided into two groups on the basis of type of operation by alternate methods. In Group A (n=32), laparoscopic varicocelectomy was performed while in Group B (n=28), open inguinal method was used. Their clinical presentations, operation times, postoperative pain, analgesic requirement, hospital stay and postoperative complications were noted and analyzed. Results: Out of 60 patients included, the age range was from 18-30 years.41.6% patients were asymptomatic and were referred to us because they were declared unfit for recruitment. Left sided varicocele was diagnosed in 81.6% patients, while 16.6% were bilateral. Grade II was most common seen in 60% of patients. Operation time for unilateral laparoscopic varicocelectomy was 17.25±2.1minutes, while open unilateral time was 42.5±3.4 minutes. Post-operative pain and hospital stay were significantly better in laparoscopic group (p value<.001). Postoperative wound related complications and secondary hydrocele was more in open group. In laparoscopic group, subcutaneous emphysema was noted in early postoperative period in 3 patients (9.3%) and portside hernia in one patient (3.1%). Recurrence rate was more in open cases (14.2%), versus 6.2% in laparoscopic group. Conclusion: Laparoscopic varicocelectomy is a simple and safe technique causing minimal morbidity with early recovery and better surgical outcome. Keywords: Varicocele, Laparoscopic Ligation, Open ligation