Electrocoagulation versus clips in laparoscopic varicocelectomy in boys

INTRODUCTION: Varicocele occurs in about 15% of adolescents, but it is hardly ever noticed in children under 10 years old. Surgical treatment in adolescents is still controversial. Objectives: The aim of this work was to assess the outcome of laparoscopic varicoelectomy by using electrocoagulation versus clips. MATERIALS AND METHODS: In the Pediatric Surgery and Urology Departments of the Medical University of Wroclaw, 139 boys with varicocele were operated on by using laparoscopy between 1995 and 2007. In total, 68 (49%) patients appeared for the control ultrasound after the surgery, and only those patients were included in this study. The spermatic vessels (both the artery and the vein) were trans-sected by monopolar diatermy (38 patients; 55.8%) or clips (29 patients; 42%). The spermatic Artery was saved in 5 cases, which have been operated on by using diatermy and in 3 by using clips. The follow-up was from 0.5 to 7 years (mean, 2.7 years). RESULTS: Among 68 patients from the control group of persistent varicocele with grade II and grade III (Dubin-Amelaar classification) were recognized in 5 (7.3%) boys. In the group of boys, who have been operated on by using diatermy, persistent varicocele was noticed in 10.5% (4), while in those who have been operated on by using clips, the persistent varicocele was recognized only in 3.4% (1). Varicocele with grade I, not demanding a second operation, was recognized in 9 boys (14.7%). The most often found complication was hydrocele. It was recognized in 23.7% (9) boys operated on by using diatermy and in 13.8% (4) boys operated on by using clips. CONCLUSIONS: Varicocelectomy using clips gives much less complications then the electrocoagulation and should be firstly chosen