Background: Varicoceles are tortuous, abnormally dilated scrotal veins. Although there are variations in recurrence rates, none of the surgical techniques outlined for varicocelectomy have been shown to be superior to the others in their ability to increase fertility.
Aim of the work: Comparison between open and laparoscopic varicocelectomy in bilateral varicocele regarding outcome and complications.
Patients and Methods: One-hundred patients with bilateral primary varicocele and sperm count below 20 million/c.c., were randomly allocated into either open surgical varicocelectomy via sub inguinal approach, or laparoscopic varicocelectomy. For each patient, operative time, recovery rate and complications were reported. Semen analysis, serum sex hormones [Testosterone, FSH and LH] levels were analyzed preoperatively, 3 and 6 months after surgery.
Results: In the laparoscopic group, there was statistically significant lower operative time than the open group [22±8.6 vs. 28±6.2; P=0.03]. Also, the laparoscopic group had significant lower hospital stay [P=0.01] and rapid return to normal activity [P=0.01] than the open group. Regarding complications, four patients in the laparoscopic group developed pneumo-scrotum versus none in the open group [P=0.01]; otherwise, the overall complication rate was higher in the open group [P=0.04]. Sperm count and motility were improved in both groups after 3 and 6 months; however, abnormal forms of sperms were improved only in the laparoscopic group [P=0.05].
Conclusion:  Laparoscopic varicocelectomy was associated with shorter operative time, hospital stay, and rapid return to normal activity. Furthermore, overall complication rate was less with laparoscopic varicocelectomy except for pneumo-scrotum, which was more frequent with laparoscopic varicocelectomy.