A systematic review and meta-analysis on the efficacy of internal spermatic artery ligation during laparoscopic varicocelectomy in children and adolescents: Is it safe?
https://doi.org/10.4081/aiua.2023.11627
Accepted: August 3, 2023
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Introduction: Challenges in identifying small testicular arteries and lack of microscopic experience have led to a rising trend in the use of laparoscopic technique for pediatric and adolescent varicocele. The controversy over artery ligation (AL) and artery preservation (AP) during laparoscopic varicocelectomy (LV) is still debatable. This study investigates the effectiveness of AL and AP during LV in pediatric and adolescent varicocele cases. Methods: The systematic searches based on PRISMA guideline were conducted in PubMed, Scopus, ScienceDirect, Web of Science and ProQuest databases with pre-defined keywords. Both quantitative and qualitative analyses were performed to assess catch-up growth, persistence, recurrence, hydrocele, operative time, post-operative testicular volume, and sperm analysis. Results: A total of 1512 patients from 9 eligible studies were included. There were no significant differences in catch up growth (OR 0.89; 95%CI 0.53, 1.51; p = 0.68) or hydrocele incidence (OR 0.59; 95%CI 0.28, 1.24; p = 0.16). The recurrence rate and persistence rate in AP group is significantly higher compared to AL group (OR 2.95; 95%CI 1.53, 5.68; p = 0.001 and OR 5.13; 95% CI 2.04, 12.88; p = 0.0005, respectively). The mean operative time during laparoscopic varicocelectomy is significantly longer when arteries are preserved as opposed to when they are ligated (OR 5.33; 95%CI 2.05, 8.60; p = 0.001). AL and AP both improved testicular volume and post-operative sperm analysis. Conclusions: AL showed higher efficacy and comparable safety to AP. We recommend using AL with lymphatic sparing to minimize hydrocele complications.
Vanlangenhove, P., Everaert, K., Van Maele, G. & Defreyne, L. Tolerance of glue embolization under local anesthesia in varicoceles: A comparative study of two different cyanoacrylates. Eur J Radiol 83, 559–563 (2014). DOI: https://doi.org/10.1016/j.ejrad.2013.11.018
Elbardisi, H. et al. Does the number of veins ligated during microsurgical subinguinal varicocelectomy impact improvement in pain post-surgery? Transl Androl Urol 6, 264–270 (2017). DOI: https://doi.org/10.21037/tau.2017.03.56
Park, S. et al. Impact of internal spermatic artery preservation during laparoscopic varicocelectomy on recurrence and the catch-up growth rate in adolescents. J Pediatr Urol 10, 435–440 (2014).
Yu, W., Rao, T., Ruan, Y., Yuan, R. & Cheng, F. Laparoscopic Varicocelectomy in Adolescents: Artery Ligation and Artery Preservation. Urology 89, 150–154 (2016). DOI: https://doi.org/10.1016/j.urology.2015.11.028
Chrouser, K., Vandersteen, D., Crocker, J. & Reinberg, Y. Nerve injury after laparoscopic varicocelectomy. Journal of Urology 172, 691–693 (2004). DOI: https://doi.org/10.1097/01.ju.0000129368.47533.f8
Esposito, C. et al. Results and complications of laparoscopic surgery for pediatric varicocele. in Journal of Pediatric Surgery vol. 36 767–769 (W.B. Saunders, 2001). DOI: https://doi.org/10.1053/jpsu.2001.22956
Youssef, T. & Abdalla, E. Single incision transumbilical laparoscopic varicocelectomy versus the conventional laparoscopic technique: A randomized clinical study. International Journal of Surgery 18, 178–183 (2015). DOI: https://doi.org/10.1016/j.ijsu.2015.04.048
Esposito, C. et al. Two decades of experience with laparoscopic varicocele repair in children: Standardizing the technique. J Pediatr Urol 14, 10.e1-10.e7 (2018). DOI: https://doi.org/10.1016/j.jpurol.2017.06.017
Parrilli, A., Roberti, A., Escolino, M. & Esposito, C. Surgical approaches for varicocele in pediatric patient. Transl Pediatr 5, 227–232 (2016). DOI: https://doi.org/10.21037/tp.2016.09.11
Hassan, J. M., Adams, M. C., Pope, J. C., Demarco, R. T. & Brock, J. W. Hydrocele Formation Following Laparoscopic Varicocelectomy. Journal of Urology 175, 1076–1079 (2006). DOI: https://doi.org/10.1016/S0022-5347(05)00402-7
Méndez-Gallart, R., García-Palacios, M., Rodríguez-Barca, P., Estévez-Martínez, E. & Bautista-Casasnovas, A. Quince años de experiencia en el tratamiento laparoscópico del varicocele pediátrico con un solo puerto de trabajo y tecnología Ligasure®. Cir Pediatr 36, 33–39 (2023). DOI: https://doi.org/10.54847/cp.2023.01.8
Tong, Q. et al. Lymphatic sparing laparoscopic Palomo varicocelectomy for varicoceles in children: intermediate results. J Pediatr Surg 44, 1509–1513 (2009). DOI: https://doi.org/10.1016/j.jpedsurg.2008.10.049
Fast, A. M., Deibert, C. M., Van Batavia, J. P., Nees, S. N. & Glassberg, K. I. Adolescent varicocelectomy: does artery sparing influence recurrence rate and/or catch-up growth? Andrology 2, 159–164 (2013). DOI: https://doi.org/10.1111/j.2047-2927.2013.00142.x
Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, n71–n71 (2021). DOI: https://doi.org/10.1136/bmj.n71
Sterne, J. A. C. et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. The BMJ 366, (2019).
Varlet, F. et al. Laparoscopic Treatment of Varicoceles in Children Multicentric Prospective Study of 90 Cases. Eur J Pediatr Surg 11, 399–403 (2001). DOI: https://doi.org/10.1055/s-2001-19728
Lund, L. et al. Testicular catch-up growth after varicocele correction in adolescents. Pediatr Surg Int 15, 234–237 (1999). DOI: https://doi.org/10.1007/s003830050564
Yehya, A., Abdalrazek, M., Gamaan, I., Fathy, A. & Batal, W. El. Lymphatic sparing laparoscopic varicocelectomy with or without testicular artery preservation: is there a difference? Annals of Pediatric Surgery 16, (2020). DOI: https://doi.org/10.1186/s43159-020-00030-2
Kim, K. S. et al. Impact of internal spermatic artery preservation during laparoscopic varicocelectomy on recurrence and the catch-up growth rate in adolescents. J Pediatr Urol 10, 435–440 (2014). DOI: https://doi.org/10.1016/j.jpurol.2013.11.003
Zampieri, N. et al. Varicocele and Adolescents: Semen Quality After 2 Different Laparoscopic Procedures. J Androl 28, 727–733 (2007). DOI: https://doi.org/10.2164/jandrol.107.002600
Esposito, C. et al. Laparoscopic treatment of pediatric varicocele: a multicenter study of the italian society of video surgery in infancy. J Urol 163, 1944–1946 (2000). DOI: https://doi.org/10.1016/S0022-5347(05)67604-5
Poon, S. A., Kozakowski, K. A., DeCastro, G. J., Gjertson, C. K. & Glassberg, K. I. Adolescent varicocelectomy: Postoperative catch-up growth is not secondary to lymphatic ligation. J Pediatr Urol 5, 37–41 (2009). DOI: https://doi.org/10.1016/j.jpurol.2008.08.002
Yaman, O., Soygur, T., Zumrutbas, A. E. & Resorlu, B. Results of microsurgical subinguinal varicocelectomy in children and adolescents. Urology 68, 410–412 (2006). DOI: https://doi.org/10.1016/j.urology.2006.02.022
Koyle, M. A., Oottamasathien, S., Barqawi, A., Rajimwale, A. & Furness, P. D. Laparoscopic palomo varicocele ligation in children and adolescents: Results of 103 cases. in Journal of Urology vol. 172 1749–1752 (Lippincott Williams and Wilkins, 2004). DOI: https://doi.org/10.1097/01.ju.0000138676.68054.67
Riccabona, M., Oswald, J., Koen, M., Lusuardi, L. & ... Optimizing the operative treatment of boys with varicocele: sequential comparison of 4 techniques. The Journal of … (2003) doi:10.1016/S0022-5347%2805%2963988-2. DOI: https://doi.org/10.1016/S0022-5347(05)63988-2
Poddoubnyi, I. V. et al. Laparoscopic ligation of testicular veins for varicocele in children: A report of 180 cases. Surg Endosc 14, 1107–1109 (2000). DOI: https://doi.org/10.1007/s004640000136
Islam, S., islam, M., Sarkar, S. & Paran, S. Outcome of laparoscopic varicocelectomy with mass ligation technique for symptomatic varicocele. Archives of Surgery and Clinical Research 3, 065–069 (2019). DOI: https://doi.org/10.29328/journal.ascr.1001037
Mirilas, P. & Mentessidou, A. Microsurgical subinguinal varicocelectomy in children, adolescents, and adults: Surgical anatomy and anatomically justified technique. Journal of Andrology vol. 33 338–349 Preprint at https://doi.org/10.2164/jandrol.111.013052 (2012). DOI: https://doi.org/10.2164/jandrol.111.013052
Fine, R. G., Gitlin, J., Reda, E. F. & Palmer, L. S. Barriers to use of semen analysis in the adolescent with a varicocele: Survey of patient, parental, and practitioner attitudes. J Pediatr Urol 12, 41.e1-41.e6 (2016). DOI: https://doi.org/10.1016/j.jpurol.2015.06.015
Kattan, S. The Impact of Internal Spermatic Artery Ligation during Laparoscopic Varicocelectomy on Recurrence Rate and Short Post Operative Outcome. Scand J Urol Nephrol 35, 218–221 (2001). DOI: https://doi.org/10.1080/003655901750291999
Fallara, G. et al. Treatment of Persistent or Recurrent Varicoceles: A Systematic Review. European Urology Focus vol. 9 531–540 Preprint at https://doi.org/10.1016/j.euf.2022.11.008 (2023). DOI: https://doi.org/10.1016/j.euf.2022.11.008
Chung, S. D. et al. Minilaparoscopic varicocelectomy with preservation of testicular artery and lymphatic vessels by using intracorporeal knot-tying technique: Five-year experience. World J Surg 35, 1785–1790 (2011). DOI: https://doi.org/10.1007/s00268-011-1115-6
Liang, Z. et al. Lymphatic sparing versus lymphatic non-sparing laparoscopic varicocelectomy in children and adolescents: A systematic review and meta-analysis. European Journal of Pediatric Surgery vol. 21 147–153 Preprint at https://doi.org/10.1055/s-0031-1271733 (2011). DOI: https://doi.org/10.1055/s-0031-1271733
Islam, S. R., Paul, D., Sarkar, S. A., Islam, S. S. & Hanif, M. Laparoscopic Varicocelectomy by Artery Preserving and Mass Ligation Technique- A Comparative Study. J Biomed Eng Med Imaging 9, (2022). DOI: https://doi.org/10.14738/jbemi.96.13498
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