LAPAROSCOPIC PALOMO VARICOCELE LIGATION IN CHILDREN AND ADOLESCENTS: RESULTS OF 103 CASES
ABSTRACT
Purpose:
We evaluate our experience using the laparoscopic Palomo varicocele ligation (LPV) technique in male children and adolescents with varicoceles.
Materials and Methods:
Between September 1994 and September 2002, 122 varicoceles were treated using LPV with either mass cord vascular clip application (68) or LigaSure (Valleylab, Boulder, Colorado) vascular sealing (54). All procedures were performed as day surgery cases and patients were allowed to return to normal activities as soon as they could tolerate them. Followup was scheduled for 6 to 12 weeks and 1 year postoperatively. Testicular size was evaluated using a Prader orchidometer.
Results:
Of the 122 patients 103 were evaluable at the initial postoperative visit and 96 at 1-year followup. Patient ages ranged from 9 to 19 years (mean 14.6). Operating time was 9 to 52 minutes (mean 28), although in the last 2 years (28 cases) mean operative time has decreased to 14.6 minutes. Indications for surgery included ipsilateral testicular hypotrophy in 84 cases, symptoms in 3 and parental choice in 16. At followup only 1 recurrent varicocele (vascular sea-lant group) was identified which was subsequently re-treated successfully using vascular sealant LPV. At 1 year 64 of 78 testes (82%) demonstrated catch-up growth and there was no evidence of testicular loss or persistent hypotrophy in the others. Reactive hydroceles were identified in 6 patients equally distributed between the 2 LPV techniques. Surgery was required on 2 of these hydroceles due to size, and the other 4 are small and are being observed. Temporary scrotal emphysema occurred in the vast majority of patients and 1 patient required laparoscopic closure of a small sigmoid serosal tear. No patients required narcotic medications for greater than 48 hours.
Conclusions:
LPV is a highly successful method to correct varicoceles in young males with catch-up growth similar to series using other accepted standard techniques. LPV can be performed safely and rapidly as an outpatient and allows early return to activity. As with the open Palomo technique, hydrocele is a bothersome complication that may require a second surgical procedure if correction is warranted.
From the Department of Pediatric Urology, Children's Hospital and Departments of Surgery/Urology and Pediatrics, University of Colorado School of Medicine, Denver, Colorado
Correspondence: Department of Surgery/Urology and Pediatrics, The Children's Hospital, B-463, 1056 E. 19th Ave., Denver, Colorado 80218 (telephone: 303-837-2680; FAX: 303-864-5572)
Papers Presented at Annual Meeting of the Section on Urology, American Academy of Pediatrics
† Financial interest and/or other relationship with Bayer, Mentor, Q-Med, Alza and Cook
‡ Financial interest and/or other relationship with Q-Med
ABSTRACT