A Natural "Venous Bypass" Causing Postoperative Recurrence of a Varicocele

¹ Department of Surgery "A" Assaf Harofeh Hospital, Tel Aviv University Medical School, Zerifin, Israel
² Department of Gynecology/Obstetrics, Assaf Harofeh Hospital, Tel Aviv University Medical School, Zerifin, Israel

Operative treatment of varicocele by anatomically high ligation of the internal spermatic vein carries a 5% surgical failure rate, resulting in recurrence. Detection of the cause of the recurrence can be done efficiently by intraoperative internal spermatic phlebography. In this case report, an unusual collateral vein causing operative failure is described with its management. The subject, a 28-year-old man, was seen for recurrence of varicocele following operative treatment by anatomically high ligation of the internal spermatic vein. An unusual collateral venous "bypass" of the ligated vein was detected by phlebography. Reoperation using the lower transinguinal approach was curative. The operative correction of recurrence of varicocele by transinguinal approach combined with phlebography is recommended.

     Key words: varicocele, spermatic phlebography, recurrent varicocele, anomalous internal spermatic collateral

Submitted on December 28, 1979
Revised on August 22, 1980
Accepted on September 19, 1980