Impact of incision level on early postoperative pain after microsurgical varicocelectomy in young men with high occupational physical demands

Microsurgical varicocelectomy is the preferred surgical treatment for painful varicocele. However, whether incision level influences early postoperative recovery in young men with high occupational physical demands remains unclear. This study compared early postoperative outcomes between inguinal and subinguinal microsurgical approaches. We conducted a retrospective comparative study of 98 young men with high occupational physical demands who underwent microsurgical varicocelectomy for painful left varicocele between January 2022 and July 2024. Patients were allocated to the Inguinal Group (MIV, n = 50) or the Subinguinal Group (MSV, n = 48) using a non-randomized alternating allocation sequence based on admission order. Key outcome measures included operative time, Visual Analog Scale (VAS) scores for wound pain (postoperative days 1, 3, and 5) and scrotal pain (postoperative months 1 and 3), rescue analgesia usage, and complication rates. Overall pain improvement (VAS ≤ 2 at 3 months) was achieved in 95.9% of patients, with no significant difference between groups. Both surgical approaches achieved comparable long-term scrotal pain improvement. Operative time was significantly longer in the MSV group (mean difference 23.5 min; 95% CI: 16.5–29.9; P < 0.001). However, patients undergoing MSV experienced significantly lower early postoperative wound pain on postoperative days 1 to 5 (mean VAS difference ranging from 0.6 to 1.3 points; P < 0.001). The MSV group also had a lower requirement for rescue analgesia (12.5% vs. 34.0%; OR 0.28, 95% CI 0.10–0.78). No cases of recurrence or hydrocele were observed during follow-up. Both microsurgical approaches provide effective treatment for painful varicocele in young men with high occupational physical demands. The subinguinal approach was associated with modestly lower early postoperative wound pain but requires longer operative time. Because objective functional recovery outcomes were not assessed, the potential occupational implications of these findings should be interpreted cautiously.