Introduction:   Varicocele  contributes  up  to  20-40%   of male  factor  in  lry  infertility.  Open surgery  has  been  the  primary  management   in  the  form  of  high,  inguinal   or  subinguinal approaches.  Laparoscopic  varicocelectomy   was  introduced  in early  1990's,  claimed  for less postoperative morbidity. There are still controversy regarding the ideal technique for varicocelectomy.

Objectives:   To  compare   the  surgical    trauma,   effect  on  semen  parameters   and  costs  of laparoscopic  versus  open  high  ligation  varicocelectomy   in  a group  of subfertile  males  with bilateral varicocele.

Patients   and  methods:    Fifty-eight   subfertile   males  were prospectively   randomized   for the study.   Patients were stratified  into 2 groups, 29 patients each.  Palomo   operation  was done to the  1st group,  while  laparoscopic   varicocelectomy   was  performed   in  the  2nd  group.   The results     were   evaluated    in   terms   of   operative    time,   hospitalization    period,   analgesic requirements,   costs, return to activities  and complications.

Results:   Operative time was less in first group (P<0.0001).     However,  postoperative  return to activities,     complications    and   recurrences    were   less - in   laparoscopy    group   (P<0.0001). Expenses  were  lower  in  open  surgery  (P<0.0001).    Semen  parameter   improvements   were equal  in both groups with no statistically  significant  difference (P>0.05).

Conclusion:      Laparoscopic    varicocelectomy,     although    needs   special    skill,    and   more expensive,   is better  than  open  surgery,   especially  in bilateral  cases  due  to  early  return  to activity; reproducibility  and less complications.