Exploring the Impact of Laparoscopic High Ligation on Varicocele: Insights Into Effective Treatment Outcomes

BACKGROUND: Varicocele is an abnormal dilatation of the pampiniform plexus commonly presenting as dull testicular pain in young adults. It is associated with primary infertility in 35% of men. Surgery is the definitive treatment of varicocele. Laparoscopic high ligation is a minimally invasive technique and is especially useful in bilateral cases and when combined with other abdominal surgery. Post-operative complications include testicular atrophy, hydrocele formation and recurrence. OBJECTIVE: To evaluate and report the initial experience of laparoscopic high ligation of varicocele, assess postoperative complications, determine recurrence rates, and measure the efficacy in improving symptoms among patients. METHODOLOGY: This cross-sectional study was conducted at General Surgery Department Hayatabad Medical Complex Peshawar, from March 2018 to April 2021. A total of 57 patients with grade II & III varicocele were selected for laparoscopic varicocelectomy. The patients were followed up for 6 months with a physical examination, Visual analog scale, and ultra-sonographic scanning for persistent pain, hydrocele formation and recurrence of varicocele. Post-stratification Chi-square test was used with P-value <0.05. RESULTS: The mean age was 34.2±6 years (range 15–42 years). Unilateral varicocele was presenting 54(94.7%) patients with left 49(85.9%) and right 5(8.77%). Bilateral were found in 3(5.26%) cases. The varicocele was grade III in 42(73.68%) and grade II in 15(26.31%) patients. The preoperative mean visual analog scale score was 4.7 and the postoperative pain at 6 months was 0.7. After the surgery, 48(84.2%) patients had significant improvement in their pain scores (p <.001), while 7(12.28%) had mild improvement and 2 (3.5%) remained unchanged. No recurrence and hydrocele was found at 6 months follow-up. CONCLUSION: Laparoscopic varicocelectomy is effective in the treatingt symptomatic varicoceles with reduced complications and good post-operative pain relief.