Question Title: Varicocele surgery

What type of surgery is used to remove or fix a varicocele? How long is the procedure and what is involved? And what is the recovery time?

Dear Tom,
A varicocele is an abnormal dilation of the pampiniform plexus of veins surrounding the testis. They are more common on the left but can occur bilaterally. The prevalence of varicoceles in the general population is estimated to range between 13-15%. Varicoceles are usually asymptomatic however as they become larger, they can cause pain. The management of pediatric varicoceles is still controversial, but more often then not, the decision is to correct them. Prophylactic varicocelectomy in an adolescent with grossly normal testes has not been shown to have a positive effect upon either future testicular development or fertility.
There are three commonly used surgical approaches to perform a varicocelectomy, an extraperitoneal approach, the inguinal approach and the subinguinal approach. The later two procedures allow for both ligation of the internal and external spermatic veins to prevent recurrence. A fourth option which has gained some popularity as an alternative to surgery is the percutaneous approach. This involves catheterization of the femoral vein. The internal spermatic vein is approached and occluded using a variety of materials. Initially there were many failures but with more experience, success is similar to the retroperitoneal approach. This is due to the fact that the external spermatic veins are not occluded.
All of these procedures are relatively short in terms of operating room time. They should last less than an hour. The recovery time from this procedure is similar to a hernia repair lasting several weeks.
Over all the success of these operations are all very good. The complications are rare and usually minor. Some patients get a post-operative hydrocele(3%) and less than one percent have wound infections or recurrences. The biggest decision you need to determine is the necessity of the operation. Are the appropriate indications present to proceed with the operation.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:Varicocele

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