Regarding: “Pediatrics Varicocele Surgery: 10 Years of Experience in Two Pediatric Surgical Centers”

Dear Editor:

Since publication of our series in 2010, ¹ where we reported a varicocele recurrence/persistence rate of 21% in a series of 19 cases (spermatic artery and lymphatic sparing), we have converted exclusively to the mass ligation technique.

The procedure is performed by standard three-port laparoscopy or the single-incision laparoscopic (SILS) technique, and the spermatic vessels are ligated with Ligaclip^® (Ethicon, Blue Ash, OH) ligating clips and divided 4–5 cm proximal to the internal inguinal ring. This single surgeon series now has an additional 5 patients (mean age, 10.9 years) having undergone mass ligation of the vessels (3 SILS, 2 standard laparoscopy), and we are pleased to report as yet no recurrences, testicular shrinkage, and one self-limiting hydrocele.

We wish to fully endorse the message ² that spermatic artery-sparing surgery is inappropriate in children, because of the high failure rate. Furthermore, we support the need for prospective multicenter data collection to establish the best of several possible approaches to treatment of this problem in children.