Ligation of the testicular artery and vein in adolescent varicocele.

Proper surgical management of adolescent varicocele is controversial. Recent evidence suggests that the Palomo approach gives the best results. We report on the outcomes of 43 consecutive adolescent boys who underwent operative correction of varicocele by a single surgeon from 1979 to 1992. An inguinal approach with ligation of the vascular pedicle above the vas deferens (modified Palomo) was used in each case. From 1979 to 1983 an attempt was made to preserve the testicular artery but it was successful in only 6 of 12 cases. After 1983 no further attempt was made to preserve the artery and, therefore, 37 patients underwent total ligation of the vascular pedicle above the entry of the vas deferens into the spermatic cord. Most of the varicoceles were grade II. Significant discrepancy in testicular volume (10% difference) constituted the main indication for operation. The ipsilateral (left) testis was smaller in 30 of 37 patients (81%). Of those testes with size discrepancy 90% showed significant volume increase following surgery. Many left testes assumed the same volume as the normal right testis. The only surgical failure (recurrence) of the 43 cases occurred in 1 of the 6 in which artery preservation was successful. There were no surgical failures in the group of 37 boys. Mean followup is 3.7 years. Total ligation of the testicular vascular pedicle seems to afford catch-up growth for smaller ipsilateral testes with low risk for recurrence of the varicocele.