Download PDF
Eur J Pediatr Surg 2011; 21(3): 147-153
DOI: 10.1055/s-0031-1271733
Review

© Georg Thieme Verlag KG Stuttgart · New York

Lymphatic Sparing Versus Lymphatic Non-Sparing Laparoscopic Varicocelectomy in Children and Adolescents: A Systematic Review and Meta-Analysis

Z. Liang[*] , 1 , J. Guo[*] , 1 , H. Zhang2 , C. Yang2 , J. Pu2 , H. Mei2 , L. Zheng3 , Q. Tong2
  • 1Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Department of Urology, Wuhan, China
  • 2Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Department of Pediatric Surgery, Wuhan, China
  • 3Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Department of Pathology, Wuhan, China
Further Information

Publication History

received November 13, 2010

accepted after revision January 05, 2011

Publication Date:
24 February 2011 (online)

    Permissions and Reprints

Abstract

Objective: The aim of this study was to explore the true efficacy and potential advantages of lymphatic sparing laparoscopic varicocelectomy (LSV) over lymphatic non-sparing laparoscopic varicocelectomy (LNSV) in children and adolescents.

Methods: A search was made for studies published up until 31 August 2010 using the terms “lymphatic sparing varicocelectomy”, “laparoscopy”, “adolescent” and “children” in the Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) comparing LSV and LNSV were included. A systematic review and meta-analysis was performed using odds ratios (ORs) for dichotomous variables.

Results: Out of 127 studies, 2 RCTs and 4 OCSs were eligible for inclusion, comprising 489 cases of LSV and 307 cases of LNSV. The hydrocele rates after LSV were significantly lower than after LNSV (OR=0.19; 95% confidence interval [CI]=0.10 to 0.36; p<0.00001). However, no significant difference was observed between LSV and LNSV with regard to recurrence (OR=0.65; 95% CI=0.32–1.33; p=0.24) or catch-up growth (OR=2.14; 95% CI=0.97–4.72; p=0.06).

Conclusion: LSV is valuable in reducing the incidence of postoperative hydrocele, with similar recurrence and catch-up growth rates as LNSV. A series of RCTs are warranted to explore the efficacy of LSV in the management of varicocele in children and adolescents.

Key words

lymphatic sparing varicocelectomy - laparoscopy - adolescent - children - meta-analysis

References

  • 1 Kass EJ, Freitas JE, Bour JB. Adolescent varicocele: objective indications for treatment.  J Urol. 1989;  142 579-582
    Google Scholar
  • 2 Evers JL, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review.  Lancet. 2003;  361 1849-1852
    Google Scholar
  • 3 Fretz PC, Sandlow JI. Varicocele: current concepts in pathophysiology, diagnosis, and treatment.  Urol Clin North Am. 2002;  29 921-937
    Google Scholar
  • 4 Diamond D. Adolescent versus adult varicoceles – how do evaluation and management differ?.  J Urol. 2009;  181 2418-2419
    Google Scholar
  • 5 Kass EJ, Belman AB. Reversal of testicular growth failure by varicocele ligation.  J Urol. 1987;  137 475-476
    Google Scholar
  • 6 Diamond DA. Adolescent varicocele: emerging understanding.  BJU Int. 2003;  92 48-51
    Google Scholar
  • 7 Skoog SJ, Roberts KP, Goldstein M. et al . The adolescent varicocele: what's new with an old problem in young patients?.  Pediatrics. 1997;  100 112-121
    Google Scholar
  • 8 Szabo R, Kessler R. Hydrocele following internal spermatic vein ligation: a retrospective study and review of the literature.  J Urol. 1984;  132 924-925
    Google Scholar
  • 9 Misseri R, Gershbein AB, Horowitz M. et al . The adolescent varicocele. II: The incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long-term follow-up.  BJU Int. 2001;  87 494-498
    Google Scholar
  • 10 D’Alessio A, Piro E, Beretta F. et al . Lymphatic preservation using methylene blue dye during varicocele surgery: A single-center retrospective study.  J Pediatr Urol. 2008;  4 138-140
    Google Scholar
  • 11 Gershbein AB, Horowitz M, Glassberg KI. The adolescent varicocele I: Left testicular hypertrophy following varicocelectomy.  J Urol. 1999;  162 1447-1449
    Google Scholar
  • 12 Kocvara R, Dolezal J, Hampl R. et al . Division of lymphatic vessels at varicocelectomy leads to testicular oedema and decline in testicular function according to the LH-RH analogue stimulation test.  Eur Urol. 2003;  43 430-435
    Google Scholar
  • 13 Riccabona M, Oswald J, Koen M. et al . Optimizing the operative treatment of boys with varicocele: sequential comparison of 4 techniques.  J Urol. 2003;  169 666-668
    Google Scholar
  • 14 Kocvara R, Dvorácek J, Sedlácek J. et al . Lymphatic sparing laparoscopic varicocelectomy: a microsurgical repair.  J Urol. 2005;  173 1751-1754
    Google Scholar
  • 15 Zwahlen M, Renehan A, Egger M. Meta-analysis in medical research: Potentials and limitations.  Urol Oncol. 2005;  26 320-329
    Google Scholar
  • 16 Häuser W, Bernardy K, Uçeyler N. et al . Treatment of fibromyalgia syndrome with antidepressants: a meta-analysis.  JAMA. 2009;  301 198-209
    Google Scholar
  • 17 Zhang J, Yao X, Yu R. et al . Exhaled carbon monoxide in asthmatics: a meta-analysis.  Respir Res. 2010;  11 50
    Google Scholar
  • 18 Kocvara R, Dolezal J, Hampl R. et al . Division of lymphatic vessels at varicocelectomy leads to testicular oedema and decline in testicular function according to the LH-RH analogue stimulation test.  Eur Urol. 2003;  43 430-435
    Google Scholar
  • 19 Glassberg KI, Poon SA, Gjertson CK. et al . Laparoscopic lymphatic sparing varicocelectomy in adolescents.  J Urol. 2008;  180 326-331
    Google Scholar
  • 20 Golebiewski A, Krolak M, Komasara L. et al . Dye-assisted lymph vessels sparing laparoscopic varicocelectomy.  J Laparoendosc Adv Surg Tech A. 2007;  17 360-363
    Google Scholar
  • 21 Poon SA, Kozakowski KA, Decastro GJ. et al . Adolescent varicocelectomy: postoperative catch-up growth is not secondary to lymphatic ligation.  J Pediatr Urol. 2009;  5 37-41
    Google Scholar
  • 22 Schwentner C, Radmayr C, Lunacek A. et al . Laparoscopic varicocele ligation in children and adolescents using isosulphan blue: a prospective randomized trial.  BJU Int. 2006;  98 861-865
    Google Scholar
  • 23 Ivanissevich O. Left varicocele due to reflux; experience with 4 470 operative cases in forty-two years.  J Int Coll Surg. 1960;  34 742-755
    Google Scholar
  • 24 Palomo A. Radical cure of varicocele by a new technique: preliminary report.  J Urol. 1949;  61 604-607
    Google Scholar
  • 25 Lemack GE, Uzzo RG, Schlegel PN. et al . Microsurgical repair of the adolescent varicocele.  J Urol. 1998;  160 179-181
    Google Scholar
  • 26 Shafik A, Khalil AM, Saleh M. The fasciomuscular tube of the spermatic cord. A study of its surgical anatomy and relation to varicocele. A new concept for the pathogenesis of varicocele.  Br J Urol. 1972;  44 147-151
    Google Scholar
  • 27 Kocvara R, Dvorácek J, Sedlácek J. et al . Lymphatic sparing laparoscopic varicocelectomy: a microsurgical repair.  J Urol. 2005;  173 1751-1754
    Google Scholar
  • 28 Oswald J, Körner I, Riccabona M. The use of isosulphan blue to identify lymphatic vessels in high retroperitoneal ligation of adolescent varicocele – avoiding postoperative hydrocele.  BJU Int. 2001;  87 502-504
    Google Scholar
  • 29 Tan HL, Tecson B, Ee MZ. et al . Lymphatic sparing, laparoscopic varicocelectomy: a new surgical technique.  Pediatr Surg Int. 2004;  20 797-798
    Google Scholar
  • 30 Barot P, Neff M, Cantor B. et al . Laparoscopic varicocelectomy with lymphatic preservation using methylene blue dye.  J Laparoendosc Adv Surg Tech A. 2004;  14 183-185
    Google Scholar
  • 31 Stradling B, Aranha G, Gabram S. Adverse skin lesions after methylene blue injections for sentinel lymph node localization.  Am J Surg. 2002;  184 350-352
    Google Scholar
  • 32 Salhab M, Al Sarakbi W, Mokbel K. Skin and fat necrosis of the breast following methylene blue dye injection for sentinel node biopsy in a patient with breast cancer.  Int Semin Surg Oncol. 2005;  2 26
    Google Scholar
  • 33 Govaert GA, Oostenbroek RJ, Plaisier PW. Prolonged skin staining after intradermal use of patent blue in sentinel lymph node biopsy for breast cancer.  Eur J Surg Oncol. 2005;  31 373-375
    Google Scholar
  • 34 Al-Said S, Al-Naimi A, Al-Ansari A. et al . Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches.  J Urol. 2008;  180 266-270
    Google Scholar
  • 35 Al-Kandari AM, Shabaan H, Ibrahim HM. et al . Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial.  Urology. 2007;  69 417-420
    Google Scholar
  • 36 Kass EJ, Belman AB. Reversal of testicular growth failure by varicocele ligation.  J Urol. 1987;  137 475-476
    Google Scholar
  • 37 Cayan S, Akbay E, Bozlu M. et al . The effect of varicocele repair on testicular volume in children and adolescents with varicocele.  J Urol. 2002;  168 731-734
    Google Scholar
  • 38 Chan PT, Wright EJ, Goldstein M. Incidence and postoperative outcomes of accidental ligation of the testicular artery during microsurgical varicocelectomy.  J Urol. 2005;  173 482-484
    Google Scholar
  • 39 Wegner H, Meier T, Miller K. Testicular necrosis after antegrade sclerotherapy of varicocele.  Int Urol Nephrol. 1996;  28 357-358
    Google Scholar
  • 40 Barroso J, Andrade DM, Novaes H. et al . Surgical treatment of varicocele in children with open and laparoscopic palomo technique: a systematic review of the literature.  J Urol. 2009;  181 2724-2728
    Google Scholar

1 Both authors have contributed equally to this article.

Correspondence

Dr. Qiangsong TongMD, PhD 

Union Hospital of Tongji

Medical College

Huazhong University of Science

and Technology

Department of Pediatric

Surgery

1277 Jie Fang Avenue

430022 Wuhan

China

Phone: +86 27 6377 6478

Fax: +86 27 8572 6197

Email: qs_tong@hotmail.com

      >