Information about your procedure from

The British Association of Urological Surgeons (BAUS)

This leaflet contains evidence-based information about your proposed

urological procedure. We have consulted specialist surgeons during its
preparation, so that it represents best practice in UK urology. You should
use it in addition to any advice already given to you.
To view the online version of this leaflet, type the text below into your web
browser:
http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Varico lap.pdf

Key Points
• This procedure involves clipping the testicular veins inside your
abdomen (tummy) using a telescope
• Almost all varicoceles (collections of varicose veins) occur above the
left testicle
• The “keyhole” procedure is normally performed under general
anaesthetic

What does this procedure involve?

Tying or clipping the swollen testicular veins that cause a varicocele
(pictured).

This is done by passing a

laparoscope (telescope)
into your abdominal
(tummy) cavity through a
small incision in your
abdominal wall, to see and
clip the swollen veins on
the back wall of your
abdominal cavity.

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What are the alternatives?
• Observation – if your varicocele causes no significant problems, no
treatment is needed
• Radiological embolisation - using interventional radiology to block
the swollen veins without surgery
• Open repair – tying off the swollen veins through a surgical incision
in your groin

What happens on the day of the procedure?

Your urologist (or a member of their team) will briefly review your history
and medications, and will discuss the surgery again with you to confirm
your consent.

An anaesthetist will see you to discuss the options of a general anaesthetic

or spinal anaesthetic. The anaesthetist will also discuss pain relief after the
procedure with you.

We usually provide you with a pair of TED stockings to wear, and we may
give you a heparin injection to thin your blood. These help to prevent blood
clots from developing and passing into your lungs. Your medical team will
decide whether you need to continue these after you go home.

Details of the procedure

• a full general anaesthetic is normally used and you will be asleep
throughout the procedure.
• you may be given an injection of antibiotics before the procedure,
after you have been checked for any allergies
• we inflate your abdominal cavity with carbon dioxide gas through a
special needle
• the operation is performed through several “keyhole” access ports
• using a telescope put in
just below your
umbilicus (belly
button), we identify the
large veins draining
blood from your testicle
along the back wall of
your abdominal cavity
(pictured)
• we tie or clip the veins
• we close the keyhole incisions with absorbable sutures which
normally disappear within two to three weeks

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 • we inject local anaesthetic around all the port sites to relieve any
early discomfort you may have
• you will be given fluids to drink immediately after the operation and
we will encourage you to move as soon as you are comfortable (to
help prevent blood clots forming in your legs)

Are there any after-effects?

The possible after-effects and your risk of getting them are shown below.
Some are self-limiting or reversible, but others are not. We have not listed
very rare after-effects (occurring in less than 1 in 250 patients) individually.
The impact of these after-effects can vary a lot from patient to patient; you
should ask your surgeon’s advice about the risks and their impact on you as
an individual:

After-effect Risk
Temporary shoulder tip pain due to
Between 1 in 2 &
irritation of your diaphragm by the carbon
1 in 10 patients
dioxide gas

Temporary abdominal bloating (gaseous Between 1 in 2 &

distension) 1 in 10 patients

The external appearance of the varicocele

Between 1 in 2 &
may not change much initially although the
1 in 10 patients
symptoms usually disappear
Bleeding, infection, pain or hernia in one
Between 1 in 10 &
(or more) of the port sites, requiring
1 in 50 patients
further treatment

Between 1 in 10 &
Failure to cure the varicocele
1 in 50 patients

Development of a hydrocele (fluid swelling Between 1 in 10 &

around the testicle) at a later stage 1 in 50 patients

Bleeding needing conversion to open Between 1 in 50 &

surgery or requiring blood transfusion 1 in 250 patients

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Damage to or shrinkage of the testicle if the Between 1 in 50 &
blood supply is reduced by the operation 1 in 250 patients

Recognised (or unrecognised) injury to

nearby local structures (blood vessels, Between 1 in 50 &
spleen, liver, kidney, lung, pancreas, bowel) 1 in 250 patients
requiring more extensive surgery

Anaesthetic or cardiovascular problems Between 1 in 50 &

possibly requiring intensive care (including 1 in 250 patients
chest infection, pulmonary embolus, stroke, (your anaesthetist
deep vein thrombosis, heart attack and can estimate your
death) individual risk)

What is my risk of a hospital-acquired infection?

Your risk of getting an infection in hospital is approximately 8 in 100 (8%);
this includes getting MRSA or a Clostridium difficile bowel infection. This
figure is higher if you are in a “high-risk” group of patients such as patients
who have had:
• long-term drainage tubes (e.g. catheters);
• bladder removal;
• long hospital stays; or
• multiple hospital admissions.

What can I expect when I get home?

• you may get some swelling and bruising of your groin and scrotum
for a few days
• you may be given a scrotal support which you should wear for the
first few days to help reduce any swelling.
• it is advisable to take some simple painkillers such as paracetamol to
help keep discomfort at bay for the first few days.
• Your stitches do not need to be removed and usually disappear after
two to three weeks, although this may take slightly longer
• you will be given advice about your recovery at home
• you will be given a copy of your discharge summary and a copy will
also be sent to your GP
• any antibiotics or other tablets you may need will be arranged &
dispensed from the hospital pharmacy
• try to avoid any heaving lifting or strenuous exercise for the first few
days

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 • you may return to work when you are comfortable enough and when
your GP is satisfied with your progress
• if you develop a temperature, increased redness, throbbing or
drainage from any of the keyhole sites, you should contact your GP
immediately
• we will provide you with information about your follow up
appointment

Will this get rid of the swollen veins in my scrotum?

Not immediately. The swollen veins above your left testicle may actually
become more prominent and uncomfortable at first, because they
thrombose (clot off) after the surgery. Eventually, they will become less
obvious but they rarely disappear completely.

General information about surgical procedures

Before your procedure
Please tell a member of the medical team if you have:
• an implanted foreign body (stent, joint replacement, pacemaker,
heart valve, blood vessel graft);
• a regular prescription for a blood thinning agent (warfarin, aspirin,
clopidogrel, rivaroxaban or dabigatran);
• a present or previous MRSA infection; or
• a high risk of variant-CJD (e.g. if you have had a corneal transplant, a
neurosurgical dural transplant or human growth hormone
treatment).

Questions you may wish to ask

If you wish to learn more about what will happen, you can find a list of
suggested questions called "Having An Operation" on the website of the
Royal College of Surgeons of England. You may also wish to ask your
surgeon for his/her personal results and experience with this procedure.

Before you go home

We will tell you how the procedure went and you should:

• make sure you understand what has been done;

• ask the surgeon if everything went as planned;
• let the staff know if you have any discomfort;
• ask what you can (and cannot) do at home;
• make sure you know what happens next; and
• ask when you can return to normal activities.

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We will give you advice about what to look out for when you get home.
Your surgeon or nurse will also give you details of who to contact, and how
to contact them, in the event of problems.

Smoking and surgery

Ideally, we would prefer you to stop smoking before any procedure.
Smoking can worsen some urological conditions and makes complications
more likely after surgery. For advice on stopping, you can:
• contact your GP;
• access your local NHS Smoking Help Online; or
• ring the free NHS Smoking Helpline on 0800 169 0 169.

Driving after surgery

It is your responsibility to make sure you are fit to drive after any surgical
procedure. You only need to contact the DVLA if your ability to drive is
likely to be affected for more than three months. If it is, you should check
with your insurance company before driving again.

What should I do with this information?

Thank you for taking the trouble to read this information. Please let your
urologist (or specialist nurse) know if you would like to have a copy for
your own records. If you wish, the medical or nursing staff can also arrange
to file a copy in your hospital notes.

What sources have we used to prepare this leaflet?

This leaflet uses information from consensus panels and other evidence-
based sources including:
• the Department of Health (England);
• the Cochrane Collaboration; and
• the National Institute for Health and Care Excellence (NICE) .

It also follows style guidelines from:

• the Royal National Institute for Blind People (RNIB);
• the Patient Information Forum; and
• the Plain English Campaign.

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Disclaimer
We have made every effort to give accurate information but there may still
be errors or omissions in this leaflet. BAUS cannot accept responsibility for
any loss from action taken (or not taken) as a result of this information.

PLEASE NOTE
The staff at BAUS are not medically trained, and are unable to answer
questions about the information provided in this leaflet. If you do have
any questions, you should contact your urologist, specialist nurse or GP.

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Due for review: April 2020 © British Association of Urological Surgeons (BAUS) Limited