Laparoscopic Ligation of Varicocele
A varicocele is a collection of large varicose veins around the testis. The left side is affected in 90% of cases. Small varicoceles are common, usually assymptomatic and do not require treatment. Larger varicoceles can cause scrotal discomfort and in some cases can impair fertility by increasing the temperature within the testicles thus impairing sperm production.
Varicoceles arise because of faulty valves within the very long left gonadal vein. They typically first become noticeable during adolescence. Symptoms include a dragging ache within the scrotum which is worse during periods of prolonged standing and relieved by lying down.
Surgical repair of varicocele is indicated for a symptomatic varicocele or in a man with a varicocele and impaired seminal parameters who has not been able to conceive with his partner (assuming female fertility is normal).
Varicocele repair entails blocking the large veins draining the affected testis. A number of techniques are possible including an open operation through the groin, a laparoscopic approach and radiological embolisation of the vein. My preferred initial approach is laparoscopic.
The procedure is performed under a general anaesthetic. Three small incisions are made in the lower abdomen (a single 10mm and two 5mm incisions) through which laparoscopic instruments are inserted. The abdominal cavity is filled with gas to distend it then the gonadal vein draining the testis is identified and two clips are placed across it to obstruct it. The instruments are then removed and wounds closed. Most men are able to head home the following day.
Aspirin, clopidogrel, dabigatran, warfarin and any other blood thinning medications will need to be stopped prior to surgery. We will advise you on the timing of when to stop and re-start these medications.
A urine sample needs to be provided to the laboratory 1 week prior to surgery.
There will be some abdominal pain and shoulder tip pain due to the surgery. This is usually adequately controlled with simple analgesics. You should avoid heavy lifting for six weeks in order to allow the wounds to heal and gain sufficient strength.
If the varicocele was repaired due to fertility issues then semen analysis is repeated three monthly to gauge the effect of surgery on seminal parameters.
Return to work
Most men will be able to return to sedentary work after 2 weeks.
I will see you three months following surgery to assess your recovery.
Risks recognised as common or serious are listed below but this does not include the rare and extraordinary
- Varicocele recurrence. This is due to filling of the veins via other 'collateral' veins. These veins may be located in the scrotum, groin or higher. This situation is best dealt with by radiological embolisation of the collateral veins.
- Bleeding - rare but may require a return to the operating theatre
- Damage to bowel - very rare
- Damage to blood vessels supplying the leg - very rare