Transperitoneal internal spermatic vein ligation

Varicocele refers to the elongation, expansion, and distortion of the variegated venous plexus. The veins from the testis and epididymis form the varicocele plexus, which enters the inguinal canal through the inguinal canal to collect 3 to 4 veins. After the inner ring enters the peritoneum, it merges into 1 or 2 internal spermatic veins. Finally, the right internal spermatic vein slanted into the inferior vena cava, and the left side enters the left renal vein at a right angle. Clinically, left varicocele is the most common. High ligation of the internal spermatic vein is a common surgical method for the treatment of varicocele. It is suitable for patients with good collateral circulation and no collateral venous reflux. There are two kinds of paths for surgery: one is laparoscopic surgery, which has been widely carried out, but special equipment is required. The other is open surgery. Open surgery also has two kinds of paths: one is through the inguinal incision, the internal spermatic vein is ligated at the inner ring; the other is through the axillary approach, the internal spermatic vein is ligated in the high retroperitoneal space. Both have their own advantages and disadvantages: the former has a shallow anatomical level and is easy to reveal, but there are many branches of the spermatic vein, which are easy to be missed or misplaced. The latter has a deeper anatomical level, but the internal spermatic vein is very Less branching, easy to accurately ligature. The indications, contraindications, preoperative preparation, anesthesia, postural position and postoperative treatment of the two were the same. Treatment of diseases: varicocele Indication Retroperitoneal spermatic vein ligation is indicated for primary varicocele, with good collateral circulation or no collateral venous reflux. The following conditions are available for indications: 1, there are serious symptoms, invalid by non-surgical treatment. 2, there are testicular spermatogenic dysfunction, accompanied by testicular atrophy, causing infertility. 3, accompanied by inguinal hernia or hydrocele. Contraindications Secondary varicocele; primary varicocele, if the collateral circulation is poor, collateral venous reflux is considered taboo. Preoperative preparation 1, clear varicocele is primary, and the collateral circulation is good. 2. Shave the pubic hair 1d before surgery and clean the vulva. Surgical procedure Incision Make a 4 to 5 cm long skin incision from the inner ring point. The incision is parallel to the inguinal ligament. After the subcutaneous tissue is cut, the aponeurosis of the external oblique muscle is cut obliquely. 2. Reveal the armpit The intra-abdominal oblique muscle and the transverse abdominis muscle were bluntly separated by a vascular clamp, and then the transverse transverse fascia was cut open, and the peritoneum was pushed inward to reveal the axillary fossa. 3. Separation of the spermatic vein The incision and the peritoneum were retracted with a deep hook, and the internal spermatic vein, vein and vas deferens were seen in parallel at the inner ring. Continue to pull up and see the vas deferens turning inward and downward. Inside the spermatic cord, the vein turns to the upper rear. The internal spermatic vein is aggregated into one after the retroperitoneum, and occasionally there are 2 to 3 veins. In the spermatic vein, there is often a layer of loose connective tissue surrounding the retroperitoneum, separating the internal spermatic vein, taking care not to damage the internal spermatic artery. 4. Cut off the internal vein of the spermatic cord The separated internal spermatic vein clamp was cut, and the two ends were double-ligated. 5. Suture incision After complete hemostasis, the wound was not drained, and the abdominal wall incision was sutured layer by layer.