Microsurgical Varicocelectomy with Spermatic Vein to Superficial Epigastric Vein Bypass in Adolescents

Introduction: A microsurgical venous bypass between the internal spermatic vein (ISV) and inferior epigastric vein was proposed five decades ago for varicocele treatment. Limitations of this technique include large incision, transverse fascia transection, delayed recovery, and mandatory venography to rule out external iliac vein compression (present in ~10% of patients). To address the limitations, a modified microsurgical varicocelectomy with internal spermatic to superficial epigastric vein (SEV) bypass was developed and evaluated in this study. Materials and Methods: The ISV–SEV bypass was performed in all adolescents (≤18 years) undergoing microsurgical varicocelectomy between May 2021 and October 2023 for left testicular hypotrophy, pain, or oligospermia. The first 100 consecutive cases were analyzed. Outcomes included length of hospital stay, complications, recovery time, postoperative Doppler parameters (testicular volume, reflux, anastomosis patency), recurrence, and improvement in testicular volume and semen characteristics. Minimum follow-up was 12 months. Results: Mean patient age was 15.5±1.15 years. Main indications included hypotrophy (72%) and oligospermia (24%). Median operative time was 55 minutes (range 45-90). All patients were discharged within 24 hours. Median return to school and sports was 4.5 and 14 days, respectively. Testicular volume improved in 54/72 patients with hypotrophy. All oligospermic patients showed significant sperm count improvement (mean 15.2 to 88.2 million; P < 0.0001). Rates of atrophy, hydrocele, hematoma, and recurrence were 0%, 0%, 2%, and 1%, respectively. Residual Doppler reflux or persistent varices were noted in 11 patients, but without clinical relevance. Conclusions: Microsurgical varicocelectomy with ISV-SEV bypass appears to be a safe and feasible technique in adolescent patients, with encouraging short-term outcomes regarding testicular volume recovery and semen parameters. Low complication and recurrence rates are promising but further studies are needed to assess the benefit over standard techniques.