Laparoscopic and open varicocelectomies advantages and disadvantages with subsequent Fertility recovery results

Background and Objectives: With laparoscopic varicocelectomy (LVV) invention, controversial ideas are developed regarding choosing the preferable method for surgical management of varicocele; accordingly, various comparative studies are required to evaluate safer and more productive technique. This study is aimed in observation of validity of both laparoscopic and inguinal open methods and their efficiency in producing fruitful male fertility progression. Cases and methods: This study is performed in a period of one-year (2017-2018), during which (60) cases of infertility due to varicocele pathophysiological consequences collected by simple random method. Of these (32) cases were laparoscopically managed (Group 1) and the other (28) cases managed by open inguinal method (Group 2). In these patients the basal spermatic analysis performed the parameters were below normal values. The presences of varicoceles were proved clinically and by ultrasound Doppler studies. The varicocelectomy operations for non-fertile purposes were excluded from study. The follow up carried on two monthly intervals for next (6) months by clinical examinations, US and BSA. Statistically SPSS version package 24 is used; presented data are used.

Varicocelectomy is a surgery performed to ligate that worm like enlarged veins, It's by far the most commonly performed surgery for the treatment of male infertility (Ding et al., 2012). The goal of treatment of the varicocele is to obstruct the refluxing venous drainage to the testis while maintaining arterial and lymphatic supplies, or to restore normal physiological blood flow to testes (Kantartzi et al., 2007;Ding et al., 2012).
Accordingly, it was found that at least 50% of patients return to be fertile (Bebars et al., 2000;Ding et al., 2012).
Minimum normal basal sperm (BSA) analysis memorandum according WHO is 20/40/60 where 20 million is for sperms count, 40 percent is for minimum sperms motility and 60% for normal sperms percentage (Bebars et al., 2000;Ding et al., 2012). Clinically varicoceles are divided into three grades (I, II & III) depending on the prominence of dilated veins.
Pathological consequences of vericocele on the testis and the contained sperms quality are due to hyperemic and hyper thermic media which will be yielded after tortious dilation of testicular veins (Kantartzi et al., 2007;Eisenberg & Lipshultz, 2011;Belay et al., 2016;Flannigan et al., 2017).

Aim of the study
This study is aimed to evaluate and draw a correct balance in between (LVV) and In the open cases we used old high inguinal approach a technique described    From the Table 1 the longer operation time significantly observed in LVV group Postoperative significant collection of hematomata is observed in the scrotum and ended by hydrocele subsequently in (OVV) group which was nearly not present in (LVV) group (Table 2). Also, the BSA parameter changes were slow and more stable for producing better conceiving rate significantly in the OVV group, but faster and less stable and productive for (LVV) and the (P-Value was less than 0.05) ( Table 3). Drop-down in the LVV but arise to normal in OVV  (Kantartzi et al., 2007;Eisenberg & Lipshultz, 2011;Belay et al., 2016; Vol.8, No.2, 2020 Alsaikhan et al., 2016;Chiba & Fujisawa, 2016).
In their study, Chiba & Fujisawa (2016) claimed that (Perry, 2001;Kantartzi et al., 2007;Chiba & Fujisawa, 2016) this had been supposed to be due to progression of adverse effect of varicocele on spermatogenesis which can be attributed to many factors such as an increased testicular temperature, increased intra-testicular pressure, hypoxia due to attenuation of blood flow, reflux of toxic metabolites from the adrenal glands and hormonal profile abnormalities (Kantartzi et al., 2007). Accordingly, we observed only 20 (33,4%) patients of this study cases got conceived after operation.
The sole inclusions for surgery in the study were the proved presence of clinical varicocele with subfertility seminal parameters, even when there was no compliant. This was based on the idea that early correction of varicocele will not only stop the progressive pathophysiological adverse changes but also will prevent future infertility in younger male patients (Cohen, 2001;Perry, 2001;Chan, 2011 (Cohen, 2001;Binsaleh & Lo, 2007;Borruto et al., 2010).

Conclusions:
Laparoscopic varicocelectomy is a macroscopical and promising procedure that is easy to perform, with wide