Althought multiple treatment solutions exist, open subinguinal microsurgical varicocelectomy is currently the gold standard for this condition. The principle this surgery is to block the flow of blood back to the testis. A surgical microscope is therefore used to properly identify the different structures in the spermatic cord. The goal is to only ligate the spermatic veins. An inguinal micro-Doppler is also used to identify the spermatic artery; it ensures its integrity during the intervention. This device also promotes better dissection by ligating more small veins. The risk of recidivism is thus greatly minimized.
Secondary hydrocele: The risk is very low (less than 1%) since dissection of the spermatic cord is done under a microscope. Lymphatic tissues are not severed or ligated. Their ligatures are responsible for the appearance of a hydrocele. It can be corrected later, if necessary.
Persistent veins: It may have a persistence of dilated veins despite improved symptoms.
Recidivism: The risk of recurrence is low because of abnormal venous communications. Re intervention or embolization may be proposed.
Hematoma: A bruise is common, but a hematoma is rare. It may require drainage.
Infection: Wound infections are rare. Infected wounds can become hot, swollen, red, and painful, with significant drainage from the incision site, and patients may develop fever. If wounds become infected (usually 3 to 5 days after surgery), antibiotics may be needed.
Testicular atrophy: It is secondary to testicular ischemia since an arterial branch has been ligated It is exceptional after a varicocele cure by microscopy and micro-Doppler under inguinal. Spermatic arteries are usually all identified.