Laparoscopic Surgery of Deferential Reflux in Pediatric and Adolescent Varicocele

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BACKGROUND: This study aimed to assess whether deferential reflux in pediatricand adolescent varicocele can be successfully treated laparoscopically.MATERIALS AND METHODS: Since 2001 at our institution, 148 boys were evaluated fora left varicocele. Preoperatively,all the patients underwent ultrasound scanassessment of testicular volume and color-Doppler US (CDUS)to rule out refluxinto the internal spermatic vein (ISV), deferential vein, or cremasteric vein.Boys with ISV reflux were treated by laparoscopic transperitoneal Palomo; boyswith isolated deferential reflux or associated to ISV reflux werelaparoscopically managed adding to the former procedure, coagulation or clipping of refluxing deferential veins.RESULTS: Reflux in both the ISV and the deferential vein was observed in 21(14.1%) out 148 boys with varicocele.Only one case (0.6%) of varicocele wascaused by an isolated deferential reflux. No reflux in the cremasteric vein wasobserved. After a median follow up period of 2 years (range, 6 months-5 years),none of our patients with deferential reflux experienced varicocele recurrenceeither clinically or according to CDUS scanning.No testicular atrophy wasobserved.CONCLUSION: Our diagnostic approach is a rigorous standard for identifying allthe venous systems concurring with the varicocele. Our proposed technique withlaparoscopic interruption or coagulation of deferential veins when proved by CDUSto be refluxing may allow successful treatment for most varicoceles. This method allows reduction in recurrence of varicocele due to a missed deferential reflux.
Lingua originaleEnglish
pagine (da-a)S133-S136
Numero di pagine4
Stato di pubblicazionePublished - 2009

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