Varicocoelectomy (Open)

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 hospitalized.
• 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),
• Open inguinal approach: A single incision is made in the groin overlying the spermatic cord. The underlying muscle layers are then opened.
• The spermatic cord is isolated and opened. Each individual vein is isolated and tied off individually taking care not to injure the artery, or vas.
• 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.
• 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.

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Varicocoelectomy Open