Grade III Varicocele Surgical Treatment using Spermatic Vein-Superficial Abdominal Vein Shunt

This protocol is significant because the bypass operation proves more effective than the traditional classical operation, ensuring better outcomes. The main advantage is that it effectively rebuilds the venous stringy of the spermatic cord.

[Narrator] To begin, place the anesthetized patient on a surgical platform. Make a three-centimeter-long external oblique incision parallel to the groin through the internal ring. Cut the skin and subcutaneous tissue with a scalpel. Using a unipolar electric scalpel combined with blunt dissection, separate the aponeurosis of the external oblique and internal oblique muscles. Push open the peritoneal tissue with saline wet gauze. Then, find the flexed and thickened spermatic vein in front of the psoas major muscle and behind the peritoneum. Open the spermatic cord sheath bluntly with a vascular clamp to carefully free a spermatic vein of about six to eight centimeters in length to the proximal end. Lift the vascular sling, ligate the proximal end with a non-absorbable 2-0 suture, and cut. Lift the distal end knot and free it to the vicinity of the peritoneal junction. Use the spermatic vein with a larger diameter for the subsequent spermatic vein-inferior epigastric vein shunt. Ligate other branches of the spermatic vein with a non-absorbable 2-0 suture. On the medial aspect of the incision, identify and retract the spermatic cord. Locate the inferior epigastric vein beneath the fascia, surrounding the spermatic cord to the left of the internal ring. Lift the vascular sling and pull out the spermatic vein from the tunnel using bending forceps. Ligate the distal end with a non-absorbable 3-0 suture and cut off the vein. Reserve the proximal end using a vascular clamp for subsequent anastomosis with the distal end of the spermatic vein. After ligating the spermatic vein and releasing the inferior epigastric vein, use large bending forceps to pull out the spermatic vein from the tunnel along the extraperitoneal to the incision of the abdominal wall through the internal ring. Check that there is no tension in the connection with the free spare inferior epigastric vein. Then place six to eight 8-0 polypropylene sutures on the vein. Release the vascular clamp to ensure that the vein is full, the blood flow is smooth, and there is no blood leakage upon pressing the testicle. To close the incision, place 2-O absorbable sutures on the external oblique aponeurosis and subcutaneous tissue. Finally, use 3-0 absorbable sutures to suture the skin. Between high and low ligation of the spermatic vein, there were no significant differences in age, body mass index, varicosity degree, and testis pain score. No significant differences were observed in the length of hospital stay between group high and low ligation of the spermatic vein. The operation time for high ligation of the spermatic vein was significantly higher than for low ligation. The incidence of postoperative scrotal edema or hydrocele of the testis and acute epididymitis was lower in high ligation compared to the low ligation of the spermatic vein. The relief rates of testicular pain or distension discomfort one month after surgery were 91.8% for high and 61.78% for low ligation of spermatic vein.

The high ligation facilitates the protection of the normal anatomy or spermatic cord and the venous bypass allows rapid testicular blood drainage, aiding specific disease therapies. Doctor unfamiliar with this technique might struggle with anatomical precision. Therefore, the person should study the inferior epigastric wing and master microscopic techniques for success.