WOFAPS 2025 8th World Congress of Pediatric Surgery

Sergey Klyuev ¹, Zurab Sichinava ², Vladislav Vasiliev ³, Mustafa Azizoğlu ⁴

¹ Saratov State Medical University, Department Of Pediatric Surgery, Saratov, Russia
² AO GK MEDSI, Dep of Pediatric Surgery, Moscow, Russia
³ Far Eastern Federal University Medical Center
⁴ 1 Esenyurt State Hospital, Pediatric Surgery, Istanbul. 2 Istinye University, Department of Stem Cell and Tissue Engineering, Istanbul. 3 Pediatric Surgery Stem Cell Application Study Group (PESSCA), Istanbul, Turkey

Background
Conventional varicocele treatments show consistent outcomes but have limitations in nutcracker syndrome and venous hypertension. Microsurgical venous anastomosis offers a promising alternative by addressing hemodynamic challenges.

Objective
To explore the potential advantages of microsurgical venous anastomosis in the treatment of varicocele and to compare early clinical results with conventional Marmar procedures.

Methods
We present a retrospective analysis of 68 patients who underwent microsurgical varicocele repair with end-to-end, end-to-side, or side-to-side proximal venous anastomosis between 2015 and 2025. Of these, 27 patients underwent primary repair, while 37 were treated for recurrent varicocele following previous interventions, including Ivanissevich surgery (n=14), sclerotherapy (n=9), laparoscopic varicocelectomy (n=7), and Marmar procedure (n=7). Anastomosis was performed using proximal the left testicular vein and the great saphenous vein in 58 cases and the inferior epigastric vein in 10 cases. Outcomes were compared with a matched group who underwent conventional Marmar procedures.

Results
Microsurgical anastomosis demonstrated significant potential advantages:

1. No need for angiographic studies, unlike embolization techniques.

2. Hemodynamic redistribution: The creation of an anastomosis may reduce renal vein pressure and address nutcracker-like physiology by creating a bypass for venous outflow.

3. Intraoperative flexibility: In case of unfavorable anatomy, conversion to standard Marmar technique remained feasible.

4. Across the entire anastomosis cohort, no varicocele recurrences were observed during follow-up.

Postoperative hydrocele developed in 2 patients (2.9%).

Conclusion
While preliminary, these findings suggest that microsurgical venous anastomosis is a safe and physiologically promising evolution in varicocele management. This approach may be particularly advantageous in patients with coexisting nutcracker anatomy or high venous pressures.