varicocelectomy question

[silverback777]

hello :

i have a 3rd grade varicocele in my left testicle and a 2nd grade one in the right , no pain at all .

i am 21 years old . i am going to have  a surgery for it after a few weeks , bilateral varicocelectomy done microsurgically , the thing is , my doctor is doing the retroperitoneal approach although i have read everywhere that microsurgical varicocelectomy is done either inguinal or subinguinal , he also told me that the subinguinal approach is dangerous , which suprised me , can someone explain please , any urologists around here ?

by the way , he is a very good and popular professional doctor in here where i live , so i am confused , i want to know why is he taking this approach .

another thing , he is telling me that i have to stay away from weightlifting for about 6 weeks , does recovery from this surgery take that long , i heard that it takes about 2 to 3 weeks , why is he telling me 6 weeks ?

thank you plz reply ASAP

[silverback777]

thanks for the reply but i dont think you understood what i said , I SAID THIS DOCTOR WILL DO THE RETROPERITONEAL APPROACH """""""""""""MICROSURGICALLY"""""""""""" AND NOT , NOT OPEN VARICOCELECTOMY .

my question still stands , does this " microsurgical retroperitoneal varicocelectomy" offer advantages ??  what do you think about it ?? if it is done microsurgically using the retroperitoneal approach will it still have the same recurrence rate?? and why.

remember again that i am saying he will do it microsurgically , and NOT open palomo conventional technique.

[Dr Smitha Mathews]

Hi,

The retroperitoneal approach is also known as Palomo's procedure.

"Retroperitoneal
The retroperitoneal approach involves incision at the level of the internal inguinal ring, splitting of the external and internal oblique muscles, and exposure of the internal spermatic artery and vein retroperitoneally near the ureter. The approach has the advantage of isolating the internal spermatic vein proximally, at a level where only one or two large veins are present. In addition, the testicular artery has not yet branched at this level, and is distinctly separate from the internal spermatic veins. The major disadvantage of the retroperitoneal approach is the high incidence of varicocele recurrence secondary to the presence of parallel inguinal and retroperitoneal collateral vessels that may bypass area of ligation and rejoin the internal spermatic vein proximal to the site of ligation. It may be difficult to identified and, therefore, preserve the testicular artery and lymphatics because the they cannot be delivered into the wound at this level"
www.uhmc.sunysb.edu/urology/male_infertility/VARICOCELE_AND_ITS_TREATMENT.html
"The retroperitoneal approach offers great proximal control of the spermatic vein near its insertion at the renal vein, this approach may be accomplished laparoscopically. This technique, however, carries a high recurrence rate (nearly 15%) due to inguinal and retroperitoneal collateral veins, failure to ligate fine periarterial veins when the testicular artery is preserved, an inability to preserve lymphatics, and potential hydrocele formation when the artery and vein are ligated en bloc. This approach to varicocele ablation remains popular among pediatric urologists"
www.emedicine.com/Med/topic2757.htm

All surgical procedures carry certain amount of risk that varries from person to person.
Some procedures may carry more risk with reference to recovery and sexual function.

Since the retroperitoneal approach involves entry through the inguinal ring, which is a weak area of the abdominal wall, the duration of abstinence from heavy exertion is bound to be longer due to the potential for the development of an inguinal hernia.

However, you will need to build up to your earlier exertion levels very gradually after any surgery of this sort.

Do keep us posted on your doubts and progress.
Regards