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.