Varicocele Repair Surgery

• There are three methods in which varicoceles can be surgically treated: open surgery, laparoscopic surgery, and the third, which isn't even really surgical (it's performed by a radiologist), is percutaneous embolization.
  Open surgery. This treatment usually is done on an outpatient basis, using general anesthetic or local anesthetic. Commonly, the surgeon will approach the vein through the groin (transinguinal), but it's also possible to make an incision in your abdomen or below the groin.
  Advances in varicocele repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.
• Laparoscopic surgery. The surgeon makes a small incision in the abdomen and passes a tiny instrument through the incision to see and to repair the varicocele. This procedure requires general anesthesia.
• Percutaneous embolization. A radiologist inserts a tube into a vein in the groin or neck through which instruments can be passed. Viewing enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele. This procedure is done with local anesthesia on an outpatient basis. This procedure isn't as widely used as surgery.
• So what's best?
• According to Dr. J's article, "Do varicoceles really affect male fertility?" although most methods yield similar short-term results, open micro-surgery tends to have lower long-term complications, such as recurrences and hydroceles.  This is due to the ability to tie off all veins while sparing the arterial blood supply and lymphatic vessels.  
• Although laparoscopic varicocele ligation was once touted as a minimally invasive method of repair, several experts have demonstrated similar recovery rates with open micro-surgical methods along with equal efficacy, fewer complications, and the advantage of not having to enter the abdomen.
• The most common complications from any of these varicocelectomy procedures are hydrocele, varicocele recurrence, and testicular artery injury.  Use of the operating microscope allows for reliable identification of spermatic cord lymphatics, internal spermatic veins and venous collaterals, and the testicular artery or arteries, so that the incidence of these complications can be reduced significantly.  Thus, the microsurgical technique of "open micro-surgery" provides a safe and effective approach to varicocele repair that preserves testicular function, enhances semen quality, and improves partners' pregnacy rates.
• What to expect from Open Micro-Surgery 
  Most men prefer general anesthesia, though the procedure can be performed under local with intravenous sedation.  Time to recovery varies, but most men get back to work within 3-4 days and and resume full activity within 7-10 days.
• From mayoclinic.com:
• You may be able to return to normal, nonstrenous activities after two days. As long as you're not uncomfortable, you may return to more strenuous activity, such as exercising, after two weeks.
  
  Pain from this surgery generally is mild. Your doctor may prescribe pain medication for the first two days after surgery. After that, your doctor may advise you to take over-the-counter (OTC) painkillers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to relieve discomfort.
  
  Your doctor may advise you not to have sex for one to two weeks. You'll have to wait three or four months after surgery to get a semen analysis to determine whether the varicocele repair was successful in restoring your fertility.

• **Dr. J has recommended Open Micro-Surgery for B.**