Abstract
Introduction Identification and preservation of testicular artery and lymphatic vessels during
microsurgical varicocelectomy can be tedious if adhered encompassing venous network
is encountered. A venous bypass from internal spermatic to saphenous or inferior epigastric
vein, that have been described for varicocele treatment, may be used in such situations.
This paper describes a simplified modification of the venous bypass technique that
reroutes the testicular blood to the superficial epigastric vein, which can easily
be found in the incisional wound. Surgical technique and anastomotic patency test
are described, and indications and results are discussed.
Materials and Methods During 2020 and 2021, 32 adolescent patients underwent microsurgical varicocelectomy.
In eight patients additional microsurgical testicular vein-superficial epigastric
vein microvascular bypass was done. The indication for bypass was difficult identification
of testicular artery and/or lymphatic vessels due to adhered venous plexus.
Results Varicocele resolution was noted in all eight patients with clinical and/or semen
analysis improvement. There were no complications or recurrences. Average length of
procedure was 65 minutes. All patients were discharged within 24 hours and no antiplatelet
or anticoagulant therapy was used.
Conclusion Testicular vein to superficial epigastric vein anastomosis is a useful and simplified
venous bypass technique that reroutes the blood from the pampiniform plexus to the
femoral vein. It can be done as an adjunct to microsurgical varicocelectomy in selected
patients through a standard incision.
Keywords
varicocele - microsurgical - bypass - superficial epigastric vein
