Laparoscopic Ligation of Varicocoele

Varicocoele is the development of varicose, tortuous, dilated veins around the testicle. It occurs almost entirely on the left, related to the underlying anatomy of venous drainage on this side. 20% of normal men have varicocoele and the majority are small, asymptomatic and can be left alone.

Nonetheless, varicocoele may be associated with male factor infertility and abnormal sperm count and with impaired testicular growth in children and adolescents. Large varicocoeles may be unsightly and may produce a dragging sensation in the scrotum. However, they do not usually cause pain and treatment rarely corrects testicular pain. Treatment does appear to improve sperm count and allow normal testicular growth.

Correction of varicocoele involves ligation of the drainage veins and the artery above the scrotum, so reducing the venous backpressure and filling of the varicocoele. The varicocoele veins are not removed and some scrotal fullness will therefore persist. The varicocoele may not correct immediately following treatment but resolve over the succeeding few weeks.

Options for treatment include laparoscopic and open surgery, and radiological embolisation. The respective success rates are similar and all are performed on a daystay basis, surgery requiring a general anaesthetic. Laparoscopy appears to allow a quicker recovery and return to normal activities by 24-48 hours, with the improved vision and dissection provided by laparoscopy reducing the recurrence / failure rate.

Although most cases proceed without particular difficulty and have excellent outcomes, potential surgical complications occur overall in 10% of patients. Varicocoele recurrence or persistence (5-10%) may occur from neighbouring veins that open up to form new varicocoele channels or from veins missed at the time of surgery/embolisation. Testicular atrophy occurs in 1%. Hydrocoele (5%) is a collection of fluid around the testicle and results from lymphatic obstruction from the surgery. This can be readily surgically corrected, but requires a second operation. Haematoma (1%) may occur at the access site for the embolisation catheter with radiological treatment

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.