There are several surgical methods for varicocele. What kind of operation?

The treatment of varicocele should be differentiated according to infertility or abnormal semen quality, clinical symptoms, varicocele degree and other complications. Treatment methods include surgical treatment and non-surgical treatment, with surgical treatment as the main one. Surgical methods include traditional open surgery (including retroperitoneal approach and peritoneal groove approach), microsurgery, laparoscopic surgery and interventional embolization.

1. Transinguinal approach and infrainguinal approach: including traditional open surgery and microsurgery. The ligation of spermatic vein through subgingival incision is considered to be superior to the inguinal approach because it does not need to cut off the aponeurosis of the external oblique abdomen, and it has light pain and rapid postoperative recovery. Testicular artery, lymphatic vessel and small diameter vein can be identified, which is considered as the basis for comprehensive evaluation of postoperative complications, improvement of semen parameters and pregnancy rate of microsurgical spermatic vein ligation.

2. Retroperitoneal approach: including ligation with or without testicular artery. This operation is convenient, but the incidence of recurrent and persistent varicose veins can reach 10% to 15%.

3. Laparoscopic ligation of internal spermatic vein: Laparoscopic ligation of internal spermatic vein has achieved good results. It has the advantages of identifying and protecting testicular artery under enlarged condition and treating bilateral lesions at the same time. The recurrence rate of laparoscopic varicocele ligation is 2- 1 1%, and about 5-8% of postoperative edema occurs, but the cost is high.

4. Percutaneous embolization techniques: including anterograde and retrograde techniques. Embolization can be achieved by gelatin sponge, coil and sclerotherapy. The recurrence rate is low, and there is no postoperative edema, but the pregnancy rate after operation is not ideal, so the problems of operation failure and high cost should be considered.

To analyze the treatment of recurrent varicocele or persistent varicocele, we should fully consider the conditions of the hospital, the professional knowledge and experience of the surgeon, the wishes of patients and other factors to choose the appropriate treatment.