Does the number of veins ligated during microsurgical subinguinal varicocelectomy impact improvement in pain post-surgery?

Haitham Elbardisi, Ashok Agarwal, Ahmad Majzoub, Sami Al Said, Hossameldin Alnawasra, Kareim Khalafalla, Khalid Al Rumaihi, Abdulla Al Ansari, Damayanthi Durairaganayagam, Mohamed Arafa


Background: We examined the impact of the number of veins ligated during varicocelectomy on post-surgical improvement of pain in a group of men presenting with clinical varicocele and pain as an indication for surgery.
Methods: This is a retrospective study of patients presenting with clinical left varicocele to the male infertility unit at a teaching hospital in Qatar. Files of all patients who underwent sub-inguinal microsurgical varicocelectomy were retrieved and categorized into three groups indicating the number of spermatic veins ligated during varicocelectomy. The presence of pain was assessed during pre- and post-operation (at 3 and 6 months). Statistical analysis was performed using Kruskal-Wallis test (K) and Chi-square test (C).
Results: Out of 675 records, 207 (30.7%) patients did left varicocelectomy for pain. Their mean age was 35.3±9.2 years. Pain was assessed in 106/207 (51.2%) patients post operatively, of whom 89 (84%) reported complete resolution of symptoms. This improvement was maintained irrespective of the number of veins ligated during surgery (<5 veins: 90.0%, 5–10 veins: 81.5%, and >10 veins: 85.7%).
Conclusions: Microsurgical subinguinal varicocelectomy is a valid treatment method for patients with a symptomatic clinical varicocele. While a significant post-surgical (at 6 months) reduction of pain was detected, the number of veins ligated intraoperatively was not predictive of post-operative improvement of pain in this study population.