Microsurgical Varicocelectomy: Experience of Our Sub-Subinguinal Approach and Review of the Literature

Table 3

Surgical approaches and their complications for varicocele in researches.

Researchers	Year	Cases	Approach	Incision length (cm)	Complications (n)
Palomo [2]	1947	36 (left); 2 (bilateral)	Retroperitoneal	3–4	No surgical accident or complication report
Ross and Ruppman [12]	1982/1993	488 (left); 75 (bilateral); 2 (right)	Internal inguinal ring	2–3	Hematomas (2); Hydrocele (41)
Goldstein et al. [6]	1992	218 (left); 211 (bilateral)	Microsurgical subinguinal	2–3	Hematomas (4); Recurrences (4); Hydrocele (0); Atrophy (0); Wound infections (0)
Mehan et al. [4]	1992	51 (bilateral)	Laparoscopic surgery	3 ports (10 mm, 10 mm, 5 mm trocar)	Hydrocele (2); Shoulder pain (3); Ecchymosis (1); Scrotal emphysema (1)
Yavetz et al. [9]	1992	51 (left)	Embolization of the spermatic vein	Percutaneous	Recurrences (12)
		43	High ligation (Ivanissevich)	3–4	Recurrences (16)
		43	High ligation (Bernardi)	3–4	Recurrences (15)
lto et al. [15]	1993	56 (left)	Microsurgical subinguinal	2–3	Hydroceles (1); Recurrences (2); Edema (7)
Jarow et al. [12]	1993	46	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Bleed (1); Recurrences (1)
Ralph et al. [13]	1993	49	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Recurrences (7); Wound infection (4); Hematomas (1); Vasal injury (1)
Enquist et al. [14]	1994	4 (left); 10 (bilateral)	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Recurrences (1)
		10 (left); 23 (bilateral)	Microsurgical subinguinal	2–3	Recurrences (0)
Tauber and Johnsen [8]	1994	253 (unilateral); 32 (bilateral)	Antegrade scrotal sclerotherapy	Percutaneous	Failed surgery (57)
Marmar and Kim [7]	1994	326 (left); 140 (bilateral)	Microsurgical subinguinal	2–3	Hydroceles (4); Ecchymosis (16); Suture reaction (11); Epididymal discomfort (26); Recurrences (10); Atrophy (0)
Miersch et al. [17]	1995	44 (left); 7 (bilateral)	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Bleed (1); Shoulder pain (8)
Tan et al. [16]	1995	72 (left); 26 (bilateral)	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Pneumoscrotum (2); Wound infection (2)
Milad et al. [22]	1996	48	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Hydroceles (3); Pain (1); Wound infection (1)
Mandressi et al. [5]	1996	160	Laparoscopic surgery	2 ports (10, 5 mm trocar)	Recurrences (5); Shoulder pain (1); Hydroceles (0); Wound infections (0)
		120	Open inguinal		Recurrences (8); Shoulder pain (0); Hydroceles (2); Wound infections (7)
Shlansky-Goldberg et al. [35]	1997	149	Open inguinal (Ivanissevich)	3	Recurrences (24); Failed surgery (1); Wound infections or hematomas (10)
		197	Percutaneous embolization	Percutaneous	Recurrences (8); Failed surgery (25); Wound infections or hematomas (22)
Cayan et al. [49]	2000	142 (left); 90 (bilateral)	Retroperitoneal	3–4	Recurrences (36); Hydrocele (5)
		128 (left); 108 (bilateral)	Microsurgical high inguinal	2–3	Recurrences (12); Hydrocele (1)
Testini et al. [39]	2001	150	Microsurgical subinguinal	2–3	Pain (7); Ecchymosis (3); Hydroceles (2); Recurrences (5)
Jungwirth et al. [40]	2001	235 (unilateral); 37 (bilateral)	Microsurgical subinguinal	3–4	Hydrocele (1); Recurrences (4); Hematomas (1); Wound infection (4)
Kumar and Gupta [47]	2003	36 (unilateral); 54 (bilateral)	Microsurgical subinguinal	2–3	Recurrences (1); Hydrocele (3); Hematomas (2); Ecchymosis (1); Wound infection (8); Hydrocele (3); Atrophy (0)
Ghanem et al. [41]	2004	210 (left); 94 (bilateral)	Subinguinal Microsurgical	2–3	Recurrences (0); Hydrocele (5)
		77 (left); 32 (bilateral)	Retroperitoneal	3–4	Recurrences (8); Hydrocele (7)
Nabi et al. [29]	2004	50 (left); 15 (right); 6 (both)	Retrograde varicocele embolization	Percutaneous	Failed surgery (3); Recurrences (1)
Orhan et al. [50]	2005	68 (left); 14 (bilateral)	Microsurgical high inguinal	3–4	Recurrences (1); Wound infection (2)
		49 (left); 16 (bilateral)	Microsurgical subinguinal	2–3	Recurrences (2); Wound infection (1)
Zini et al. [42]	2005	101 (left); 64 (bilateral)	Microsurgical subinguinal	2–3	Recurrences (0); Hydroceles (0)
Watanabe et al. [18]	2005	47 (left); 3 (bilateral)	Retroperitoneal	3–4	Recurrences (6); Hydrocele (5)
		32 (left); 1 (bilateral)	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Recurrences (2); Emphysema (2); Hydrocele (1)
		60 (left); 1 (bilateral)	Microsurgical subinguinal	2–3	Recurrences (0)
Zucchi et al. [30]	2005	32 (left)	Open inguinal	4–5	Recurrences (2)
		32 (left)	Antegrade scrotal sclerotherapy	Percutaneous	Recurrences (3)
Al-Hunayan et al. [19]	2006	30	Two-trocar laparoscopic	Two ports (5, 5 mm)	Bleeding (1)
		30	Three-trocar laparoscopic	Three ports (5, 5, 5 mm)	Bleeding (2)
Al-Kandari et al. [20]	2007	28 (left); 12 (bilateral)	Open inguinal	3–4	Recurrences (7); Hydroceles (7)
		30 (left); 10 (bilateral)	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Recurrences (9); Hydroceles (10)
		35 (left); 5 (bilateral)	Microsurgical subinguinal	2–3	Recurrences (1); Hydroceles (0)
Simforoosh et al. [24]	2007	40 (left); 10 (bilateral)	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Recurrences (4); Hydroceles (7); Wound infection (0); Emphysema (8)
		44 (left); 6 (bilateral)	Open inguinal	3–4	Recurrences (2); Hydroceles (12); Wound infection (3); Emphysema (0)
Zampieri et al. [25]	2007	63	Laparoscopic (ligation)	3 ports (10, 10, 5 mm trocar)	Recurrences (0); Hydroceles (8)
		59	Laparoscopic (artery preserving)	3 ports (10, 10, 5 mm trocar)	Recurrences (5); Hydroceles (1)
Galfano et al. [31]	2008	605 (left); 85 (bilateral); 7 (right)	Antegrade scrotal sclerotherapy	Percutaneous	Failed surgery (63)
Gandini et al. [36]	2008	244	Transcatheter foam sclerotherapy	Intravenous	Allergic (1); Leakage (4); Fever (2); Recurrences (9)
Al-Said et al. [48]	2008	41 (left); 51 (bilateral)	Open inguinal	3–4	Recurrences (16); Hydroceles (4); Wound infection (2); Hematomas (2); Pain (4)
		40 (left); 54 (bilateral)	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Recurrences (25); Hydroceles (8); Wound infection (0); Hematomas (0); Pain (6)
		69 (left); 43 (bilateral)	Microsurgical subinguinal	2–3	Recurrences (4); Hydroceles (0); Wound infection (2); Hematomas (1); Pain (2)
Abdel-Maguid and Othman [43]	2010	49 (left); 33 (bilateral)	Microsurgical subinguinal	2–3	Recurrences (0); Edema (2); Hydrocele (1); Wound infection (2); Atrophy (0)
		46 (left); 33 (bilateral)	Open subinguinal	2–3	Recurrences (9); Edema (3); Hydrocele (7); Wound infection (2); Atrophy (2)
Fayez et al. [32]	2010	22 (left); 33 (bilateral)	Open inguinal (Ivauissevich)	3–4	Recurrences (6); Fever (0); Hematomas (3); Wound infection (0); Hydrocele (3); Pain (4)
		27 (left); 24 (bilateral)	Antegrade scrotal sclerotherapy	Percutaneous	Recurrences (9); Fever (3); Hematomas (5); Wound infection (1); Hydrocele (0); Pain (5)
		23 (left); 26 (bilateral)	Subinguinal Antegrade inguinal sclerotherapy	Percutaneous	Recurrences (4); Fever (2); Hematomas (0); Wound infection (1); Hydrocele (0); Pain (1)
Kim et al. [44]	2012	76 (unilateral); 5 (bilateral)	Microsurgical subinguinal	2–3	Recurrences (2); Hydrocele (0); Hematomas (1); Wound infection (1)
Shiraishi et al. [51]	2012	143 (left)	Microsurgical high inguinal	2.5–3	Recurrence (2); Hydrocele (1)
Söylemez et al. [45]	2012		Microscopic subinguinal	2–3	Wound infection (1); Hematomas (0); Atrophy (0); Orchitis (0); Edema (3); Hydrocele (1); Recurrences (1); Emphysema (0)
			Laparoscopic	3 ports (10, 10, 5 mm trocar)	Wound infection (0); Hematomas (0); Atrophy (0); Orchitis (1); Edema (1); Hydrocele (2); Recurrences (2); Emphysema (5)
Pan et al. [46]	2013	27 (unilateral); 32 (bilateral)	Microsurgical inguinal	3–4	Recurrence (3); Hydrocele (0)
		20 (unilateral); 36 (bilateral)	Microsurgical subinguinal	2–3	Recurrence (2); Hydrocele (1)
Crestani et al. [33]	2016	580 (left); 80 (bilateral); 14 (right)	Antegrade scrotal sclerotherapy	1–2	Failed surgery (4); Recurrences (40); Hematomas (12); Wound infection (9); Pain (21)
Lv et al. [21]	2016	60 (left); 24 (bilateral)	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Edema (8); Atrophy (7); Recurrence (10)
		71 (left); 24 (bilateral)	Microsurgical inguinal	3–5	Edema (3); Atrophy (5); Recurrence (3)
		68 (left); 18 (bilateral)	Microsurgical subinguinal	3–4	Edema (1); Atrophy (1); Recurrence (1)
		73 (left); 17 (bilateral)	Microsurgical retroperitoneal	3–4	Edema (2); Atrophy (4); Recurrence (2)
Shiraishi et al. [52]	2016	41	Microsurgical subinguinal	2–3	Recurrence (0); Hydrocele (1)
		40	Microsurgical high inguinal	2–3	Recurrences (0); Hydrocele (0)
Hosseini et al. [23]	2018	22	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Hematoma (1); Recurrences (5); Hydrocele (8); Pneumoscrotum (1); Pain (2)
		23	Open inguinal	3–4	Hematoma (4); Recurrences (2); Hydrocele (5); Pneumoscrotum (0); Pain (2)
		25	Retroperitoneal	3–4	Hematoma (1); Recurrences (0); Hydrocele (2); Pneumoscrotum (0); Pain (3)
McCullough et al. [26]	2018	258	Robotic-assisted Microsurgical subinguinal	2 (3 arms and 1 camera assisted)	Recurrences (25); Atrophy (0); Hydrocele (25); Hematoma (7)
Demirdöğen et al. [53]	2019	62	Microsurgical subinguinal	2–3	Recurrences (0); Atrophy (1); Hydrocele (1)
		74	Microsurgical internal inguinal	2–3	Recurrences (0); Atrophy (0); Hydrocele (0)
Teng et al. [27]	2020	45	Robotic-assisted laparoscopic varicocelectomy with g indocyanine green fluorescence angiography	3 ports (10, 10, 5 mm trocar)	Recurrences (0); Atrophy (0); Hydrocele (0)
Ouanes et al. [34]	2022	79	Open inguinal	3–4	Recurrences; hydrocele; orchitis; hematoma; wound infection (8)
		63	Antegrade sclerotherapy	Percutaneous	Recurrences; hydrocele; orchitis; hematoma; wound infection (7)
		65	Laparoscopic surgery	3 ports (10, 10, 5 mm trocar)	Recurrences; hydrocele; orchitis; hematoma; wound infection (6)