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Abstract Forty patients with bilateral symptomatic varicoceles indicated for surgical repair were included in the study. They were divided into two groups (٢٠ patients each) in a random pattern. The first group of patients underwent laparoscopic varicocelectomy and the other group underwent open high inguinal varicocelectomy (Modified Palomo). Detailed urological and medical history including general and local examination routine preoperative investigations (CBC, random blood sugar, liver function profile, BUN and serum creatinine, prothrombin time and concentration) Semen analysis, Scrotal ultrasound and Colour duplex on the pampiniform plexus of veins. Intraoperative and early post-operative evaluation was done for type of anesthesia, time of the operation, testicular artery preservation, complications, analgesia, post-operative hospital stay and return to activity Follow up ٣ months postoperative was done for improvement of semen parameters and incidence of hydroceles and recurrence . Results The mean age was ٢٤±٤.٢ and ٢٣.٢±٣.٢ years for laparoscopic and open group respectively, the difference between the two groups was statistically insignificant. Pain was the presenting symptom in ١٨ and ١٧ patients while infertility was presented in ٢ and ٤ patients respectively in laparoscopic and open group. The mean operative time was ٧٦.١±١٩.٨ minutes and ٤٧.٨±٧.٦ minutes for both laparoscopic group and open group respectively. It was significantly shorter among patients in the open group. Testicular artery could not be identified and was inadvertently divided in ١١ varicoceles (٢٧.٥%) and in ٧ varicoceles (١٧.٥%) in open group and laparoscopic group respectively. Both open and laparoscopic surgery were performed as a one day procedure and patients returned to work and daily regular activity after ٦.٩ ± ٠.٩(days) and ٣.٦ ± ١.١ (days) in open and laparoscopic procedures respectively, with a difference of statistical significance (P<٠.٠٥). The cost of open surgery was low in comparison to the cost of laparoscopy. The post operative follow up showed statistically significant results concerning semen parameters, shown in increased of the density of sperms with a mean of ٥٨.٢٥ & ٥٦.٩ million/ml, increased motility with a mean of ٦٥.٨ & ٦٣.٣٥ %and reduction of the percentage of the abnormal forms with a mean of ٢٧.٦٥ & ٢٧.٥ % for laparoscopic and open groups respectively. The recurrence rate was ٢ varicoceles (٥%) in laparoscopic group and ٤ varicoceles (١٠%) in open group. Hydroceles were reported ٤ hydroceles (١٠%) in laparoscopic group and ٨ hydroceles (٢٠%) in open group. |