An alternative surgical technique for varicoceles: a preliminary experience of the microsurgical spermatic (distal end)-inferior or superficial epigastric vein anastomosis in symptomatic varicoceles associated with perineal pain

Abstract

Many therapies are effective in treating varicoceles, including dilation of the pampiniform plexus in males. The most common method of treatment is varicocelectomy. We aimed to assess an alternative technique (microsurgical spermatic [distal end]-superficial or inferior epigastric vein anastomosis) that preserves the normal blood flow pattern for varicocele treatment. We retrospectively analyzed 27 men with varicocele between October 2019 and July 2020. All patients underwent microsurgical spermatic (distal end)-superficial or inferior epigastric vein anastomosis. The prognosis was reviewed retrospectively with an additional survey conducted 3 months after surgery. The mean ± standard deviation of the age was 26.1 ± 7.3 years in patients with microsurgical spermatic (distal end)-superficial or inferior epigastric vein anastomosis. The maximum diameter of the varicocele vein, perineal pain score, sperm density, and forward movement of sperm improved over 3 months after surgery. Microsurgical spermatic (distal end)-superficial or inferior epigastric vein anastomosis is a safe and efficient surgical treatment for varicoceles.

Commentary on “An alternative surgical technique for varicoceles: a preliminary experience of the microsurgical spermatic (distal end)-inferior or superficial epigastric vein anastomosis in symptomatic varicoceles associated with perineal pain”

“…The methods described by Wan et al . 1 and in our paper should probably not be done if the patient has venous reflux into the superficial epigastric vein (due to saphenofemoral incompetence), and previously mentioned series have also considered the possibility of the reflux into the deep inferior epigastric vein (in cases of iliac vein compression by the iliac artery). 3 This can be excluded by a preoperative Doppler examination.…”

“…This is useful when, during standard microsurgical varicocelectomy, the dissection of the internal spermatic veins around the artery is difficult, and the identification of the artery is uncertain. 2 As in Wan et al , 1 only dilated internal spermatic vein(s) are ligated and one is anastomosed to the superficial inferior epigastric vein. The rationale is that any persistent venous reflux (into the nonligated pampiniform veins) would be rerouted through the superficial epigastric vein, and will not reach the testicle due to higher vascular resistance ( ).…”

“…I have read with care the article of Wan et al . 1 on microsurgical bypass for varicocele treatment. Addressing several issues would, in my opinion, improve the quality of future research of this interesting technique, similar to the one we reported for varicocele treatment in children and adolescents.…”

“… 2 Since Wan et al . 1 utilized a more cranial approach, it would be of interest to know the duration of hospitalization and time to return to work/full physical activity in their series.…”

Microsurgical Varicocelectomy: Experience of Our Sub-Subinguinal Approach and Review of the Literature

“…Compared with open inguinal or laparoscopic surgery, these methods have no advantages except for the esthetics of the skin incision after operation [32,34,36]. Other relevant studies have suggested that the new type of varicocele bypass vein anastomosis surgery is more aligned with human anatomy than venous embolism and can achieve etiological treatment [37]. However, it is still difficult to accurately judge the efficacy of bypass surgery and the standard of postoperative reexamination.…”