Laparoscopic Varicocele Repair - Procedure, Risks, and Benefits

Introduction

The surgical procedure of laparoscopic varicocele repair involves the utilization of a laparoscope, a specialized instrument equipped with a camera and small surgical tools, to perform the operation. The laparoscope is introduced through a series of small incisions made in the abdomen.

The abdomen is inflated with the help of a gas so that the abnormal veins can be easily located. This procedure is usually carried out under general anesthesia.

Laparoscopic repair aims to identify and tie the abnormal veins to restore blood flow to the scrotum. The procedure is carried out without damaging the adjacent structures such as the arteries, and parts of the ejaculatory system. This technique has a lot of variations depending on how the dissection is carried out.

The procedure is also guided by ultrasound for fewer complications. There are two procedures for the same, artery-preserving and artery-ligating depending on whether the artery is tied up or not. The recurrence rate is lower if the arteries are tied up or ligated. The disadvantage of ligation is that it can lead to testicle shrinkage and infertility.

What Is a Varicocele?

Varicocele refers to the dilation of veins responsible for carrying deoxygenated blood away from the testicles. This occurs due to the presence of faulty valves in the veins. It can also occur due to the compression of a vein by a structure. Varicoceles are usually asymptomatic but can lead to reduced sperm production and poor quality of sperm causing infertility. Symptomatic varicoceles can be repaired surgically whereas the asymptomatic ones can be left as such.

When Is Laparoscopic Varicocele Repair Surgery Indicated?

Laparoscopic varicocele repair surgery is indicated in the following cases:

• Pain or discomfort in the testicles.

• Abnormal parameters related to the serum.

• A varicocele that can be felt clinically.

• Infertility.

• Symptoms related to abnormal development of the testes.

• Men desire fertility in the future.

• Men requiring surgery for an inguinal hernia can get it done along with the varicocele repair procedure.

How Is the Laparoscopic Varicocele Repair Surgery Performed?

Before the Procedure:

Before commencing the procedure, the surgeon will review the medical history and thoroughly examine the individual. The anesthetist will explain the different types of anesthesia options available for the sure such as general anesthesia or spinal anesthesia. A pair of TED stockings provided and a heparin injection given to make the blood thinner. This prevents the development of blood clots and their passage into the lungs.

During the Procedure:

The surgery is conducted under general anesthesia. Before starting the procedure antibiotic injections can be given after testing the person for allergies. The abdomen is inflated with the help of carbon dioxide gas with the help of a special needle. Laparoscopic surgery is performed with the help of keyholes. After the keyholes are made, a small telescope is placed just below the umbilicus.

The large veins that drain blood from the testicles along the back wall of the abdomen are identified. The veins are then tied up or clipped with the help of surgical instruments. The keyholes created are then closed with the help of absorbable sutures that usually disappear within two or three weeks. Local anesthesia is injected around all the sites to relieve any discomfort. The individual is then given enough fluids to drink immediately after the procedure and is encouraged to move as soon as possible to prevent the formation of clots in the legs.

After the Procedure:

Post-surgery the individual is taken to a recovery room until the anesthesia wears off. One may feel sleepy and nauseous. In case a breathing tube was used, the throat could be sore for some time. Painkillers are given for pain management. The catheter is removed from the bladder.

Upon being discharged, it is important to adhere to the doctor's instructions, which may include following prescribed medication schedules, tending to incisions, and applying ice or cold compresses to the scrotum for 10-minute intervals within the initial 48-hour period.

One should not take bath and keep the area wet unless suggested by the doctor. One should not indulge in sexual activity for two weeks. Try not to lift heavy objects, or perform any strenuous activities. The medicines might make one drowsy so they should abstain from driving. Straining while passing stool is not recommended.

What Are the Risks Associated With a Laparoscopic Varicocele Repair?

The risks associated with a laparoscopic varicocele repair include the following:

• Temporary pain at the shoulder tip due to irritation of the diaphragm by carbon dioxide gas.

• Abdominal bloating.

• Bleeding, infection, pain, or hernia in any of the keyholes may require further treatment.

• No change in the appearance of the varicocele initially but the symptoms may disappear.

• Not cured varicocele.

• Hydrocele - Hydrocele is the condition where fluid is filled around the testicle.

• Pain after a few days of the procedure due to inflammation of the veins lasting for a few weeks.

• Injury or shrinkage of the testicles if the blood supply is reduced during the procedure.

• Injury to the adjacent structures such as the spleen, blood vessels, liver, kidney, lungs, pancreas, and bowel, needs surgery.

• Problems arising due to anesthesia, or cardiovascular problems such as chest infection, pulmonary embolus, deep vein thrombosis, heart attack, stroke, and death.

What Are the Advantages of Laparoscopic Varicocele Repair Surgery?

The following are the benefits of laparoscopic varicocele surgery:

• Minimally Invasive - The laparoscopic surgeries are done through keyhole incisions which makes them minimally invasive.

• Less Pain - Since the surgery is minimally invasive it causes lesser pain post-surgery.

• Reduced Hospital Stay - The hospital stay following a minimally invasive surgery is much less as compared to open surgery.

• Quick Recovery - The recovery post a minimally invasive procedure is faster due to a smaller incision size. The wound heals faster comparatively.

• Reduced Scar Formation - Since the incisions are like a keyhole, they heal without forming a scar. Usually, stitches are not needed to close the wounds.

• Increased Success Rate - The laparoscopic surgeries are carried out with the help of a laparoscope. This helps the surgeon to carry out the procedure with increased precision and accuracy thereby increasing the success rate.

Conclusion:

A varicocele is a common condition caused due to enlarged veins in the scrotum. It usually occurs in the left testicle but can be found in the right one as well. An asymptomatic varicocele can be left untreated whereas treatment is required for a symptomatic varicocele. There are many treatment options available for the treatment of the condition. Laparoscopic varicocele repair surgery is a minimally invasive surgery with a speedy recovery and a good success rate.