Dr Jo Schoeman
Urological Surgeon

        

Varicocoelectomy (Laparoscopic)

Product Summary: Ligation of the testicular veins as they enter the retroperitoneal space through the internal inguinal ring.

Item Number: 30635, 105

Why is it done?

  • Painful scrotal varices
  • Male infertility
  • Exclude: Renal mass causing this!

Pre-requirements

  • An informed consent is required from the patient.
  • Patients may not eat or drink from midnight the previous evening.
  • Patients are to refrain from smoking before the procedure.
  • Patients allergic to IODINE / CHLORHEXIDINE should clearly state this to theatre staff and Dr Schoeman.
  • Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery.
  • Patients with cardiac illnesses require a cardiologist / physician’s report.
  • A chest X-ray is required for patients with lung disease.
  • Pre-op blood tests are required 4 days prior to surgery.
  • The inguinal area (area from navel to pubic bone, hip bone to midline, on affected side) is shaved once hospitalised.
  • Please ensure that the ward admission staff, the theatre staff and Dr Schoeman are made aware of the correct side on which the procedure is to be done.
  • Be prepared for an overnight stay.

How is it done?

  • This procedure is done under general anaesthetic.
  • Two options are available: Laparoscopic and open (inguinal/flank).
  • Laparoscopy: involves 3 small incisions spaced in a triangle on the lower abdomen.
  • The veins are clipped and cut as they enter the abdomen from the scrotum.
  • Subcutaneous skin sutures (which need not be removed) are used in closing, unless stated otherwise by Dr Schoeman.
  • A dressing is then applied, which should be removed after 72 hours.
  • A local anaesthetic is injected into the wound, thus giving post-operative pain relief for the next 4-6 hours.
  • A catheter will be inserted overnight.

What to expect after the procedure?

  • Any anaesthetic has its risks and the anaesthetist will explain such risks.
  • Bleeding is a common complication.
  • A haematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible. Bruising is normal.
  • An infection of the wound may occur and requires immediate review.
  • Shoulder pain, as air is trapped under the diaphragm.
  • A further complication may be that the testis may become smaller after the operation.
  • DANGER SIGNS: A wound that swells immediately, fever, or puss. Contact Dr Schoeman or the hospital immediately as this may occur in up to 10-15% of all cases.
  • There is up to a 50-60% recurrence rate after any procedure

What next?

  • The dressing should be kept dry for the initial 72 hours after surgery and then removed by soaking in a bath until it comes off easily.
  • The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
  • On discharge, a prescription may be issued for patients to collect.
  • Patients should schedule a follow-up appointment with Dr Schoeman 2 weeks after the procedure.
  • There will be signs of bruising for at least 10 days.
  • The suture-line will be hard and indurated for at least 8-10 weeks.
  • Sick leave will be granted for 14 days.
  • Please direct any further queries to Dr Schoeman’s rooms.
  • PLEASE CONTACT THE HOSPITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL SHOULD THERE BE ANY SIGNS OF SEPSIS.

Varicocoelectomy (Laparoscopic) Varicocoelectomy (Laparoscopic) (214 KB)