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Surgical Options

What are the surgical options?

Surgical approach Cost Recurrence of varicocele Improvement in Semen Potential for Morbidity
1. Paloma’s (Retroperitoneal open approach) ++ Yes 20% to 30% No
2. Laparoscopic approach +++
Very high recurrence rate.
20% Serious morbidity possible.
No proven benefit.
3. Microsurgical Trans Inguinal approach +++ No 40% to 50% No
4. Radiological balloon occlusion approach ++++ Maybe 30% to 40% No
5. Cremasteric disruption with venous ligation + Nil 97% improvement in Semen.
Pregnancy rates observed by Dr. Parag Shah
64% pregnancy rate at one year
80% pregnancy rate at 2 years.
Low cost, ambulatory (walk-in, walk-out from operating table)
High success rate.


  • The higher the approach, the higher the incidence of recurrence and low fertility rates.
  • Laparoscopic Approach: Costly. Has potential for serious morbidity.