Laparoscopic Palomo varicocele surgery: Lessons learned after 10 years' follow up of 156 consecutive pediatric patients

Objectives: To evaluate our experience using laparoscopic Palomo varicocele ligation in a population under 18 years, and confirm the factors involved in postoperative hydrocele formation. Patients and methods: Between 1997 and 2007, 156 boys diagnosed as having varicocele were evaluated retrospectively. Outcome variables recorded for analysis were age at presentation, symptoms, varicocele grade (Dubin-Amelar classification), testicular atrophy, length of hospital stay, perioperative complications, recurrence and hydrocele formation after surgery. Mean follow up was 5.6 years (6 months 9 years). Results: Age at diagnosis ranged between 9 and 18 years. Mean age at operation was 14.1 +/- 1.8 years. There were 153 left-side varicoceles (98%) and three cases were bilateral. All patients had grade II or III varicocele (38%/62%) and testicular atrophy was noted in 43.8%; 8.1% mentioned testicular pain at diagnosis. All boys underwent Palomo laparoscopic ligation of the spermatic vessels. Mean operative time was 38 min (25-82 min). The last 51 surgeries were performed on a two-trocar basis with Ligasure (R) vascular sealing device and operative time decreased significantly to 22 min (16-32 min) (P < 0.05). Median hospital stay was 31 8 h. Conversion rate was 1.28%. Twenty-one patients developed hydrocele (13.5%); 11 of these underwent Winkelman-Lord's hydrocelectomy at least 1 year after Palomo (9% of total). Of the remaining 10, two resolved spontaneously and eight were stable at mean 4-year follow up. Conclusions: Laparoscopic Palomo varicocele surgery for pediatric patients is a safe and effective procedure. Recurrence and complication rates are similar to those reported with open surgery. (C) 2008 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.