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 | +++ Costly |
Yes. 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. |
No. Low cost, ambulatory (walk-in, walk-out from operating table) High success rate. |
Conclusions
- The higher the approach, the higher the incidence of recurrence and low fertility rates.
- Laparoscopic Approach: Costly. Has potential for serious morbidity.