Background: Varicocele is the most common surgically treatable cause of male sub fertility. The underlying 
pathophysiology is unclear. Surgical ligation (varicocelectomy) is the conventional management. 
Methods: in the period from October 2000 to May 2002 we operated upon 300 patients with varicocele came to be treated from sub fertility. We used the inguinal approach in all patients. We added a new step n the operative technique, which is evacuation of the engorged distal venous stump prior to its ligation in half of the patients and tested its effectiveness in relieving the postoperative discomfort and hydrocele formation, which are the most common postoperative sequences. We aimed at exploration of the great advantages of this elderly described approach and its suitability for mostly all cases of varicocele and all types of patients and to discover the effects of ligating the internal spermatic artery at this level. We evaluated the patients postoperatively as regard the hospital stay, the postoperative course, the postoperative complications, the degree of improvement of the sperm parameters and the incidence of recurrence. 
Results: The mean operative time was 30 (20 to 55) minutes. Postoperative course was surprisingly quiescent in the patients in whom the testes were evacuated from the engorged blood before ligation of the veins and this is in contrary with the postoperative testicular heaviness that was experienced in all patients in whom ligation was done without evacuation. 
Small sized lax hydrocele occurred in 30 cases (10%). Hydrocele maintained in only 10 cases (3.3%). A total of 175 patients showed improvement in their sperm count after 6 months (58.4%). Recurrence of the varicocele was recorded in a total of 20 cases (6.9%) after 9-13 months. 
Conclusions: Inguinal approach is the best approach to deal with varicocele. It carries a lot of advantages. Evacuation of 
the distal venous stump is a very important step in minimizing the postoperative patient's discomfort.