What is varicocelectomy? Types, surgery and postoperative period

• Varicocelectomy is the only definitive treatment for varicocele problems.
• Varicocelectomy surgery can be performed in several ways, but the most common are inguinal and subinguinal.
• The postoperative period for varicocelectomy is very simple and can be carried out at home.

Varicocelectomy is a surgical procedure to alleviate the problems caused by varicocele.

Varicocelectomy is usually recommended when the patient with varicocele has any of the following symptoms:

• Significant testicular pain that causes discomfort to the patient. This is not always the case.
• Loss of testicular function. Loss of semen quality due to a reduction in the number of spermatozoa.
• Testicular atrophy. When circulation problems occur, the testicle decreases in size.

In cases where a patient with a varicocele shows signs of infertility, varicocele repair surgery is indicated to solve this problem. Varicocelectomy consists of ligating the dilated veins that make up the varicocele, and can be performed using several different surgical techniques.

There are several types of varicocelectomy depending on the type of approach chosen, with inguinal varicocelectomy and subinguinal varicocelectomy being the most commonly used today, as the retroperitoneal approach has a high percentage of potential hydrocele as does laparoscopic varicocelectomy.

Inguinal varicocelectomy

As mentioned above, inguinal and subinguinal varicocelectomy are the most common, thanks to the advantage of removing the venous plexus outside the inguinal canal and thus making it easier to identify the artery leading to the testicle, the lymphatic ducts and the other veins that make up the inguinal cord, thus allowing for more effective surgery and reducing the chances of varicocele recurrence.

Resolution of varicocele consists mainly of ligation of the internal spermatic veins, although in cases of inguinal varicocelectomy it is also possible to ligate the external spermatic veins if necessary.

The following is a step-by-step explanation of the surgical procedure for inguinal varicocelectomy surgery:

Consultation with the urologist

During the consultation with the urologist who will determine whether a varicocelectomy is necessary or not, the specialist will examine the patient to check the varicocele and will also review any other tests that have been carried out, such as an ultrasound scan.

Normally, patients with varicocele come to the urologist's office due to infertility, so in these cases the intervention is almost always recommended.

Once the patient and the specialist decide to carry out the varicocelectomy, the specialist will explain the whole process and will set a date and time for the preoperative and for the intervention.

Varicocelectomy surgery: preoperative period

The varicocelectomy operation is usually performed under regional anaesthesia and sedation, keeping the patient asleep but avoiding the need for intubation that general anaesthesia requires. 

To determine the type of anaesthesia and whether or not the patient is suitable for the operation, the following preoperative tests will be necessary:

• Complete blood test. By means of a complete blood test, the anaesthesiologist will check that the patient is fit for surgery, is in good health and does not have any type of infection, in which case it must be treated and eliminated prior to the varicocelectomy.
• Chest x-ray. This test allows us to check that there is no pulmonary pathology that contraindicates surgery.
• Electrocardiogram. The electrocardiogram allows the anaesthesiologist to check that the patient's heart is in good health and that it is suitable for the operation.

• On the day of surgery, the patient comes to the hospital a couple of hours before surgery. Before entering the operating theatre, the patient will be taken to a room where he or she will be asked to change into scrubs. Normally, the patient will be given antibiotics to prevent infection during and after the varicocelectomy.
• You will then enter the operating room where you will meet the surgeon, anaesthetist and nursing team. The anaesthesia will be administered and once the patient is under anaesthesia, the surgery will begin.
• First of all, if necessary, the inguinal area where the incision to access the inguinal canal will be made will be shaved.
• The surgeon will make an incision of about 5 centimetres and then extract the spermatic cord with a special surgical instrument, open it and ligate the internal veins that cause part of the problem, preserving the artery, the lymphatic vessels and the vas deferens. The external spermatic veins are then ligated.
• Finally, the surgeon reintroduces the venous plexus into the inguinal canal, sutures and repairs the incision site and completes the varicocelectomy.

The duration of varicocelectomy surgery usually ranges from 20 to 60 minutes, depending on whether it is a unilateral or bilateral varicocele.

After waking up, the patient is taken to an intensive care unit where he will remain until he is fully recovered.

Once the patient has woken up after varicocelectomy and regained their vital signs, they are taken to their room where they will stay overnight until they are discharged, although in many cases the patient may leave the hospital a few hours after the surgery.

Before leaving the hospital, the medical team will explain to the patient how to carry out post-operative care after varicocelectomy. 

This will consist of keeping the wound clean by washing it carefully, applying some antiseptic to reduce the chances of infection, and changing the gauze until the stitches have been removed.

Similarly, the patient will be urged to avoid heavy physical exertion after varicocelectomy for at least 2 weeks, and can return to work in approximately 4 or 5 days if it is an office job, and 15 days if it is a more physical job.

The first follow-up visit usually takes place one week after the varicocelectomy, while the rest will depend on each patient.

If varicocelectomy has been performed to treat an infertility problem,a spermiogram will be performed at 3 to 4 weeks to see if there is improvement, with optimal improvement being achieved up to a year after the procedure in some cases.