Abstract
OBJECTIVE: To explore the advantages and clinical application value of the new technique of single-port laparoscopy combined with fascial puncture needle-assisted external abdominal wall ligation of the spermatic vein compared to traditional three-port laparoscopy in the treatment of varicocele in children and adolescents, and to compare the efficacy of both methods. METHODS: A retrospective analysis was conducted on the perioperative and follow-up data of children under 18 years old with left-sided varicocele treated in the Department of Urology, Kunming Children’s Hospital, from January to December 2022. Based on the surgical approach, patients undergoing traditional three-port laparoscopy were classified into the control group, while those undergoing single-port laparoscopy combined with a fascial puncture needle-assisted technique for external abdominal wall ligation of the spermatic vein were classified into the intervention group. General patient information was collected, including age, chief complaints, symptoms, signs, and preoperative ultrasound results. Perioperative data were recorded, including surgery duration, intraoperative blood loss, hospitalization duration, hospitalization costs, and postoperative recovery status. Two-year follow-up data included complications such as postoperative low back pain, scrotal pain, incision infection, varicocele recurrence, hydrocele, and testicular atrophy. The surgical indicators and incidence of postoperative complications were compared between the two groups. RESULTS: A total of 71 patients were included in this study, with 35 children in the intervention group and 36 children in the control group. Surgery was successful for both groups, with smooth ligation of the spermatic vein in all cases, and no changes in surgical approach. There was no statistically significant difference in surgery time between the two groups (P = 0.815 > 0.05, t = 2.630). The intervention group had lower intraoperative blood loss, shorter hospitalization time, and lower hospitalization costs compared to the control group (P < 0.050). At the 2-year postoperative follow-up, physical examinations and scrotal ultrasounds showed no testicular atrophy or postoperative low back pain in either group. During the follow-up, the intervention group had one case of postoperative recurrence (2.9%), three cases of left-sided hydrocele (8.6%), and one case of intermittent scrotal pain (2.9%), with no incision infections. In the control group, there was one case of recurrence (2.8%), five cases of left-sided hydrocele (13.9%), three cases of intermittent scrotal pain (8.3%), and one case of incision infection (2.8%). There were no statistically significant differences between the groups in the incidence of hydrocele, scrotal pain, or incision infection (P > 0.050). CONCLUSION: There is no significant difference in postoperative efficacy between the two surgical methods. However, the technique of single-port laparoscopy combined with fascial puncture needle-assisted external abdominal wall ligation of the spermatic vein bundle offers advantages over traditional three-port laparoscopy, including less surgical trauma, aesthetically pleasing incisions, less intraoperative blood loss, shorter hospitalization time, and lower hospitalization costs. This method is suitable for the surgical treatment of varicocele in adolescents.