Laparoscopic Palomo Varicocele Ligation in Children and Adolescents

Abstract

Purpose:

To assess laparoscopic high spermatic cord interruption (Palomo ligation) in children and adolescents with varicoceles.

Patients and Methods:

Between 1994 and 2000, all patients with surgical indications for varicocele correction were offered the traditional choices of annual observation, radiologic occlusion, or surgical interruption using open (suprainguinal, inguinal, subinguinal/high scrotal) or laparoscopic venous interruption (LVI). Thirty eight patients chose LVI and are the subject of this analysis.

Results:

Patient ages ranged from 10 to 18 years (mean 14.6 years). The operating time was 18 to 52 minutes (mean 28 minutes). In three patients, adhesions were lysed laparoscopically, but otherwise, no ancillary procedures were performed. No intraoperative or early complications related to the surgical procedure were encountered. All operations were performed as day surgical cases, except one. The patients were off oral narcotics and back to full activity within 48 hours of the surgery. At 3- and 12-month follow-up, there were no recurrent/persistent varicoceles. All testes that were initially smaller than the contralateral gonad either demonstrated catch-up growth or remained stable in size. Two patients (5%) developed ipsilateral secondary hydroceles, one of which required surgical correction.

Conclusions:

Laparoscopic venous interruption is a rapid, effective, and safe method to treat varicoceles in young males. Given all therapeutic options, it appears that, given informed consent, LVI is an attractive alternative to traditional techniques in most males in the adolescent and peripubertal age groups. As with the open Palomo technique, hydrocele is a bothersome complication that may necessitate a second surgical procedure. This risk must be discussed preoperatively.