Comparative Study between Laparoscopic Varicocelectomy and Subinguinal Varicocelectomy in Treatment of Primary Infertility

Varicocele defined as dilated and tortuous veins of the pampiniform plexus which is the net of veins that drains blood from both testicles within the spermatic cord. varicoceles are a common identified scrotal disease. Their prevalence in the normal adult male population is 15-20% & they are thought the commonest treatable cause of male infertility. The laparoscopic and subinguinal varicocele surgery has been proven to get better outcomes in many studies. To compare two methods for varicocelectomy Laparoscopy & subinguinal in treatment of primary infertility.Patient and method: Prospective randomized study was performed about laparoscopic varicocelectomy (A) and subinguinal varicocelectomy (B) in primary infertility, from April 2018 to June 2020. Fifty patients in two groups with clinically palpable varicocele confirmed by U/S Doppler complaining of primary infertility as a main symptom with reflux of pampiniform plexus of any grade, unilateral or bilateral. All cases undergone variscocelectomy bilateral a follow up done within one year for postoperative complications, semen parameters and pregnancy rate. Resulats: There was significant difference between operative time in both groups (the mean operative time was 36.28±8.21 vs 49.72±7.89 for laparoscopic and subinguinal respectively). Laparoscopic varicocelectomy had much less pain with highly significant difference in comparison with subinguinal ligation. There was significant difference between outcomes of semen parameters at six months postoperative in both groups regarding count, motility, vitality and abnormal shapes (p ≤0.001). Pregnancy rate improved in both groups (40% vs 32% for laparoscopy and subinguinal respectively). Convalescence days (4 days in group A & 5 days in group B) But no significant difference regarding the hospital stay (one day), and postoperative complications. Conclusion: Varicocele is a highly prevalent condition in the infertile male population. The best method in varicocele treatment is yet a contentious issue. Both methods has short hospital stay, rapid recovery and sooner return to work but laparoscopic has less postoperative pain, shorter operative time and easy accessibility for bilateral varicocelectomy with better outcomes.