Internal Spermatic Vein to Superficial Epigastric Vein Microsurgical Bypass in Varicocele Treatment

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

Publication History

Received: 01 February 2022

Accepted: 26 April 2022

Article published online:
14 September 2022

• References

• 1 de Los Reyes T, Locke J, Afshar K. Varicoceles in the pediatric population: diagnosis, treatment, and outcomes. Can Urol Assoc J 2017; 11 (1-2 suppl 1): S34-S39
• 2 Jacobson DL, Johnson EK. Varicoceles in the pediatric and adolescent population: threat to future fertility?. Fertil Steril 2017; 108 (03) 370-377
• 3 Coolsaet BL. The varicocele syndrome: venography determining the optimal level for surgical management. J Urol 1980; 124 (06) 833-839
• 4 Mirilas P, Mentessidou A. Microsurgical subinguinal varicocelectomy in children, adolescents, and adults: surgical anatomy and anatomically justified technique. J Androl 2012; 33 (03) 338-349
• 5 EAU/ESPU guidelines on pediatric urology in EAU guidelines. Paper presented at the EAU Annual Congress Milan 2021. Accessed January 30, 2022, at: https://uroweb.org/guideline/paediatric-urology/
• 6 Baazeem A, Zini A. Surgery illustrated—surgical atlas microsurgical varicocelectomy. BJU Int 2009; 104 (03) 420-427
• 7 Belgrano E, Puppo P, Quattrini S, Trombetta C, Pittaluga P. Microsurgical spermaticoepigastric anastomosis for treatment of varicocele. Microsurgery 1984; 5 (01) 44-49
• 8 Camoglio FS, Cervellione RM, Bruno C. et al. Microsurgical spermatico-epigastric venous anastomosis in the treatment of varicocele in children: assessment of long-term patency. Eur J Pediatr Surg 2003; 13 (04) 256-259
• 9 Luque Mialdea R, Sanabia J, Martin Crespo R, Cerda J, Aguilar F, Arrojo F. Microsurgical treatment of varicocele in adolescents. Eur J Pediatr Surg 1995; 5 (02) 101-103
• 10 Lima M, Dòmini M, Libri M. The varicocele in pediatric age: 207 cases treated with microsurgical technique. Eur J Pediatr Surg 1997; 7 (01) 30-33
• 11 Flati G, Talarico C, Flati D. et al. Long-term results of microsurgical drainage for idiopathic varicocele. Int Urol Nephrol 1997; 29 (01) 63-69
• 12 Fox U, Romagnoli G, Colombo F. The microsurgical drainage of the varicocele. Fertil Steril 1984; 41 (03) 475-478
• 13 Flati G, Porowska B, Flati D, Carboni M. Microsurgical treatment of varicocele: selecting most appropriate shunt. Urology 1990; 35 (02) 121-126
• 14 Puleo S, Trombatore G, Lombardo R, Greco L, Rodolico M, Di Cataldo A. Microsurgery and varicocele: state of the art. Microsurgery 1998; 18 (08) 479-481
• 15 Reardon CM, O'Ceallaigh S, O'Sullivan ST. An anatomical study of the superficial inferior epigastric vessels in humans. Br J Plast Surg 2004; 57 (06) 515-519
• 16 Çayan S, Şahin S, Akbay E. Paternity rates and time to conception in adolescents with varicocele undergoing microsurgical varicocele repair vs observation only: a single institution experience with 408 patients. J Urol 2017; 198 (01) 195-201
• 17 Silay MS, Hoen L, Quadackaers J. et al. Treatment of varicocele in children and adolescents: a systematic review and meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. Eur Urol 2019; 75 (03) 448-461