Varicocelectomy Surgery in Delhi, India

It is unnecessary to treat a varicocele unless the man plans to father a baby and is part of his infertility treatment or he has continuous dragging pain in the scrotum and groin region. However, in case diagnosed in young males, it is recommended to monitor it annually.

Varicocelectomy can be performed in men who:

• Are infertile and wish to father a baby
• Have testicular pain
• Have decreased testosterone production
• Have a growing varicocele that is causing discomfort while performing routine tasks.

General contraindications for the surgery include:

• Immunocompromised individuals
• Previous scrotal surgery
• Coagulopathy
• Testicular cancer

Varicocelectomy is an outpatient procedure. Before a varicocelectomy procedure, the patient's general health is evaluated, and vitals such as pulse rate, body temperature, and blood pressure are noted. In addition, the patient must inform the doctor about the following:

• Any ongoing prescription or over-the-counter (OTC) medications, including herbal supplements. This is because they may interact with the procedure.
• Inform about any blood-thinning medicines being taken, such as aspirin, warfarin, and others.
• Inform about any allergies, even if it seems minor and unrelated. Patients must observe 6 hours of fasting before the scheduled surgery. This prevents the side effects of anaesthesia.

Varicocelectomy can be performed in two ways:

• Open surgery
• Minimally invasive surgery

Depending on what the case requires, the surgery can be performed.

Open Surgery

An incision is created to access the enlarged veins during open surgery. The following are the popular approaches in open surgery varicocelectomy:

• Inguinal ligation: This approach involves accessing the varicocele through the inguinal canal. This canal is in the groin, near the lowest part of the abdomen.
• Subinguinal ligation: The varicocele is accessed from the groin near the root of the scrotum.
• Retroperitoneal high ligation: The varicocele is accessed from behind the peritoneum, a transparent, watery membrane that lines the abdomen.

Minimally Invasive Surgery

Less invasive methods are used during minimally invasive surgery. Minimally invasive varicocelectomy procedures include:

• Laparoscopic varicocelectomy: Several tiny incisions are made in the lower abdomen, from where a laparoscope is inserted to view the varicocele. Using the same equipment, the varicocele is clipped and cut.
• Microsurgical varicocelectomy: In this procedure, incisions are made in a slightly higher area of the groin. Using a powerful operating microscope, doctors evaluate the varicocele and operate it. This procedure is the best performed in high magnification, has the best outcome and has the least complications.

Like all surgical procedures carry minimal risks, varicocelectomy may also result in some minor complications. However, these complications are often treatable and heal well. Sometimes, fluid may build up around the testicles, a condition known as hydrocele. If a person fails to maintain good hygiene, they may develop infections and may experience redness, inflammation, drainage, fever, nausea or vomiting.

The post-operative care and instructions that may be given after a varicocelectomy procedure include:

• The stitches are covered with a bandage, and the patient is moved to the recovery room.
• In the recovery room, the patient's health is monitored, after which they are discharged based on their status.
• On waking up from sedation, patients often feel soreness and discomfort in the lower abdominal and groin region.
• This discomfort and pain can be managed by analgesics and anti-inflammatory drugs prescribed by the provider.
• The recovery time for the procedure often ranges between one to two weeks. However, there may be tenderness in the groin region for up to six weeks.
• Some patients may need a prescription for antibiotics or other medications. These should be taken as directed.
• To manage pain and swelling, apply an ice pack to the affected areas for 10 minutes and repeat throughout the day.
• For better recovery, maintain personal hygiene and wash hands with soap and water before changing the bandages.
• Avoid bathing, and take showers after 48 hours or a sponge bath instead. This prevents the open wounds from getting wet or, worse, infected.
• Avoid swimming and strenuous exercises for at least four weeks post-operatively. These can cause infection and delay healing due to pressure.
• If constipated, consume high-fibre meals to relieve it. Alternatively, stool softeners or magnesium hydroxide (milk of magnesia) may be taken to relieve constipation.
• Avoid having intercourse for at least four weeks after the procedure to prevent applying pressure on the incisions.
• Depending on the comfort, one can resume work within three to four days.

Reviewed by Dr. Vijay Kumar, Associate Director & Unit Head ( Reconstructive & Laparoscopic Urology), Urology on 02-May-2023.