Combination of High Ligation and Intraoperative Embolization using Polidocanol for Treatment of Varicoceles

Summary

To reduce the postoperative recurrence rate of varicocelectomy, we combined high ligation of varicocele with intraoperative embolization. We injected polidocanol from the spermatic vein during surgery to embolize the branches of the spermatic vein and collateral veins. This is an alternative surgical method for the treatment of varicocele.

Abstract

Varicoceles are dilated veins within the pampiniform plexus and are relatively common in the general male population. The spermatic vein has many branches in the scrotal segment and then gradually merges into 1-2 trunks after passing through the internal inguinal ring. The key to a successful varicocelectomy is to ligate all the spermatic veins while protecting the testicular arteries and spermatic lymphatic vessels from damage. The small veins, including the branches of spermatic veins and collateral veins, are easily missed for ligation during conventional high ligation of varicocele, which has been suggested as a major cause of postoperative recurrence. Although microsurgery effectively reduces the risk of missing ligation of the spermatic veins during surgery, it has several shortcomings, such as long operation time and a steep learning curve. More importantly, this technique is difficult to carry out in primary hospitals due to the requirement of specialized equipment. Therefore, an attempt to modify the traditional high ligation aiming to reduce the postoperative recurrence rate has been carried out here. The protocol here combines traditional high ligation with intraoperative embolization to seal off the branches of the spermatic vein and collateral veins. We rapidly injected foamed sclerosant into the internal spermatic vein under direct observation after separation of the spermatic vein and then ligated all the veins. The foamed sclerosant through the varicose vein hampers endothelial cell growth, promotes the growth of thrombus and fibrosis, and ultimately forms fibrous streaks that permanently fill the venous. The results showed a more satisfactory effect on reducing the postoperative recurrence rate compared with traditional high ligation. Since this protocol is simple to carry out and has better results in reducing the recurrence rate, this can be an alternative surgical method for the treatment of varicocele, especially in primary hospitals.

Introduction

Varicoceles, with an incidence of approximately 15%-20% in the general male population and 35%-40% among the infertile population, is one of the major causes of infertility^1,2,3. In addition, varicoceles can cause pain and discomfort and a decline in androgen levels⁴. In recent decades, different surgical procedures have been consistently applied to treat varicoceles, including high ligation of varicocele, inguinal and sublingual micro varicocelectomy, laparoscopic spermatic vein ligation, and interventional embolization⁵. High ....

Protocol

All procedures in the following protocol were reviewed and approved by the First Affiliated Hospital, Sun Yat-sen University.

1. Patient preparation

1. Apply the following inclusion criteria: male sex; varicoceles during physical examination and on ultrasonography; infertility or abnormal semen or unrelieved pain by drugs.
2. Apply the following exclusion criteria: other known causes of male infertility, such as cryptorchidism, cancer, scrotum and reproductive .......

Discussion

This protocol presents a new surgical method for varicocele that combines traditional high ligation with intraoperative embolization to seal off the internal spermatic vein branches sufficiently. We expect to reduce the possibility of missing ligation of the small branches to reduce the postoperative recurrence rate by this method. The follow-up results show that this method can reduce the postoperative recurrence rate and improve the appearance of scrotum covered with varicose veins in the short term. The specific proce.......

Materials

Name	Company	Catalog Number	Comments
3-0 absorbable suture material	Johnson & Johnson-Ethicon	20203021529
3-0 non-absorbable suture line	Johnson & Johnson	20202020196
electrocoagulation electrotome	Shinva	20183010484
forceps	Shinva	20140168
iodophor	ADF Hi-tec Disinfectants Co., Ltd.	2019029215
polidocanol	Shanxi Tianyu Pharmaceutical Co., Ltd.	H20080445
retractor	Shinva	20150218
syringes	Medicom	20153140848