Introduction: Varicocele, defined as dilatation of the pampiniform plexus, has long been recognized as a 
treatable cause of male infertility. Varicocele results in generalized impairment of sperm production, loss of 
testicular volume as well as enzymatic impairment in the final stage of testosterone biosynthesis. 
This study aims to compare the outcome of varicocelectomy done by the open retroperitoneal high ligation 
(modified Palomo), the low ligation (subinguinal) and laparoscopic transperitoneal ligation as 
regard to: Semen parameter (sperm count, motility and percentage of abnormal sperm forms), 
serum levels of: Testosterone, FSH, LH and Prolactin and testicular volume measured by 
ultrasonography.
Patients and Methods: Between May 2006 to January 2008 a total of seventy-eight patients were chosen from 
the outpatient clinic of the Ain Shams University Hospitals to participate in this study. They were referred to 
surgery as varicoceles with either infertility (40 cases)or chronic scrotal pain (38 cases).All the patients were 
subjected to complete semen analysis ,blood sampling for hormonal assay (testosterone, FSH, LH and 
Prolactine)and underwent scrotal dopplex sonography. The 78 patients were randomly divided into three 
groups: 1
st group: Open high retroperitoneal ligation (35 patients), 2nd group: subinguinal ligation (35 cases) 
and 3rd group laparoscopic transperitoneal ligation (8 patients).
Results: There was significant improvement in all semen parameter after high ligation and subinguinal 
ligation at 3 and 6 months postoperatively (p value <0.05). The postoperative change of serum level of 
testosterone was significant after each approach at 3 and 6 months (p value <0.05). On the other hand, serum 
levels of FSH, LH and Prolactin changed insignificantly after each approach at 3 and 6 months 
postoperatively (p value>0.05).There was no significant difference in the percentage of change among the 
different operations as regard to the impact on semen parameters, testicular volume as well as the mean 
serum hormone levels postoperatively for the infertile group. The open high ligation resulted in significant 
higher incidence of postoperative hydrocele and postoperative recurrence compared with other two 
approaches.
Summary: Both subinguinal and laparoscopic approaches are more preferable than open high ligation due to 
the lesser incidence of postoperative complications (hydrocele and recurrence).