Retrospective Analysis of Laparoscopic Varicocelectomy in Pediatric Patients: Impact of Lymphatic-Sparing Techniques and Methylene Blue on Outcomes-A Series of Cases

Abstract

Objective: This study aimed to evaluate the outcomes and complications of laparoscopic varicocelectomy (LV) in pediatric and adolescent patients, comparing lymphatic-sparing (LS) and non-lymphatic-sparing (NLS) techniques, with a particular focus on the postoperative effects of methylene blue dye. Methods: A retrospective review was conducted for patients with Grade 3 left-sided varicocele who underwent LV between 2010 and 2023. Patients were grouped according to whether lymphatic-sparing techniques were used. Testicular volumes were measured pre- and postoperatively by ultrasonography. Surgical complications including hydrocele, recurrence, and intratesticular calcification were recorded. Statistical comparisons were made between the two groups. Results: A total of 21 patients with a median age of 15 years were included. LS suvrgery was performed in seven patients (33.3%), and arterial sparing in four (19%). Methylene blue was used to identify lymphatic vessels in the LS group. Postoperative hydrocele was observed in three patients (14.3%) and occurred equally in both groups. However, testicular calcification was detected only in the LS group and was significantly more common compared to the NLS group (p = 0.002). Recurrence rates were not significantly different between groups (p = 0.694). No cases of testicular atrophy were observed. The median follow-up duration was 6 years in the NLS group and 3 years in the LS group (p = 0.026). Conclusions: Lymphatic-sparing laparoscopic varicocelectomy appears effective in preserving testicular volume, but the use of intratesticular methylene blue is associated with a higher incidence of calcification. These findings highlight the need for caution and further long-term evaluation of vital dyes in pediatric varicocelectomy.