Schwentner C et al. (2006) Laparoscopic varicocele ligation in children and adolescents using isosulphan blue: a prospective randomized trial. BJU Int 98: 861–865

Laparoscopic ligation is the favored treatment for varicocele in children and adolescents. A common postoperative complication of varicocele surgery is the disruption of testicular lymphatic drainage, which results in hydrocele. Visualization of the lymphatic vessels by dye injection reduces the incidence of hydrocele after open Palomo ligation; Schwentner et al., therefore, evaluated whether lymphatic staining was feasible during laparoscopic ligation.

The authors enrolled 50 consecutive patients (aged 8–25 years) with varicocele, confirmed by scrotal color Doppler ultrasonography. The patients were randomly allocated to laparoscopic varicocele ligation only, or laparoscopic varicocele ligation following injection of 2 ml 1% isosulphan blue (under the tunica dartos, near the parietal wall of the tunica vaginalis) 15 min before surgery. The patients were followed up postoperatively at 3, 6, and 12 months and annually thereafter.

Lymphatic staining was successful in 24/25 patients. No patients allocated to the isosulphan-blue group developed hydrocele, but two patients had a blue-stained scrotum at 3 months that had resolved by the 6 month checkup. Five patients who underwent laparoscopic ligation without lymphatic staining had secondary hydroceles at 3 months, which were still present 6 months after surgery (three underwent hydrocelectomy 1 year after surgery). Varicocele persisted in two patients (one from each treatment group). The mean operative time was similar in both groups.

The authors conclude that preservation of adequate lymphatic drainage is essential to avoid postoperative hydrocele and improve the andrologic outcome of varicocele surgery. They recommend use of lymphatic staining to ensure lymphatic vessels are spared.