{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T23:08:44Z","timestamp":1784243324817,"version":"3.55.0"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>A microsurgical venous bypass between the internal spermatic vein (ISV) and inferior epigastric vein was proposed five decades ago for varicocele treatment. Limitations of this technique include a large incision, transverse fascia transection, delayed recovery, and mandatory venography to rule out external iliac vein compression (present in \u223c10% of patients). To address these limitations, a modified microsurgical varicocelectomy with internal spermatic to superficial epigastric vein (SEV) bypass was developed and evaluated in this study.<\/jats:p>\n                  <jats:p>The ISV\u2013SEV bypass was performed in all adolescents (\u226418 years) undergoing microsurgical varicocelectomy between May 2021 and October 2023 for left testicular hypotrophy, pain, or oligospermia. The first 100 consecutive cases were analyzed. Outcomes included length of hospital stay, complications, recovery time, postoperative Doppler parameters (testicular volume, reflux, anastomosis patency), recurrence, and improvement in testicular volume and semen characteristics. Minimum follow-up was 12 months.<\/jats:p>\n                  <jats:p>Mean patient age was 15.5\u2009\u00b1\u20091.15 years. Main indications included hypotrophy (72%) and oligospermia (24%). Median operative time was 55\u2009minutes (range 45\u201390). All patients were discharged within 24\u2009hours. Median return to school and sports was 4.5 and 14 days, respectively. Testicular volume improved in 54\/72 patients with hypotrophy. All oligospermic patients showed significant sperm count improvement (mean 15.2 to 88.2 million; p\u2009&lt;\u20090.0001). Rates of atrophy, hydrocele, hematoma, and recurrence were 0%, 0%, 2%, and 1%, respectively. Residual Doppler reflux or persistent varices were noted in 11 patients, but without clinical relevance.<\/jats:p>\n                  <jats:p>Microsurgical varicocelectomy with ISV\u2013SEV bypass appears to be a safe and feasible technique in adolescent patients, with encouraging short-term outcomes regarding testicular volume recovery and semen parameters. Low complication and recurrence rates are promising, but further studies are needed to assess the benefit over standard techniques.<\/jats:p>","DOI":"10.1055\/a-2770-2866","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:15:04Z","timestamp":1765584904000},"page":"339-346","source":"Crossref","is-referenced-by-count":0,"title":["Microsurgical Varicocelectomy with Spermatic Vein to Superficial Epigastric Vein Bypass in Adolescents"],"prefix":"10.1055","volume":"36","author":[{"given":"Dino","family":"Papes","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanko","family":"Cavar","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miram","family":"Pasini","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Sabolic","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anko","family":"Antabak","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Jel\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tea","family":"Rosandic","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorotea","family":"Sinjeri","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dora","family":"Skrljak Sosa","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomislav","family":"Luetic","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"ref1","first-page":"T29","article-title":"Consideration of sterility; subfertility in the male","volume":"59","author":"W S Tulloch","year":"1952","journal-title":"Edinburgh Med J"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12958-023-01054-0","article-title":"Lifestyle-, environmental-, and additional health factors associated with an increased sperm DNA fragmentation: A systematic review and meta-analysis","volume":"21","author":"A Szab\u00f3","year":"2023","journal-title":"Reprod Biol Endocrinol"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1038\/nrurol.2017.98","article-title":"Varicocele and male infertility","volume":"14","author":"C FS Jensen","year":"2017","journal-title":"Nat Rev Urol"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"29665","DOI":"10.1038\/s41598-024-81252-x","article-title":"DNA breakpoints and free DNA fragments as potential predictors of infertility","volume":"14","author":"Y Zhou","year":"2024","journal-title":"Sci Rep"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/15579883241285670","article-title":"Does sperm DNA Fragmentation Index continuously decrease over time after varicocelectomy in varicocele-induced infertility? A systematic review and meta-analysis","volume":"18","author":"L Wang","year":"2024","journal-title":"Am J Mens Health"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"931","DOI":"10.21037\/tau.2017.08.01","article-title":"Should we expand the indications for varicocele treatment?","volume":"6","author":"I Vakalopoulos","year":"2017","journal-title":"Transl Androl Urol"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S0015-0282(00)01644-7","article-title":"Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy","volume":"75","author":"T G Matkov","year":"2001","journal-title":"Fertil Steril"},{"issue":"02","key":"ref8","first-page":"505","article-title":"Effects of varicocele repair on spontaneous first trimester miscarriage: A randomized clinical trial","volume":"9","author":"M Mansour Ghanaie","year":"2012","journal-title":"Urol J"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.fertnstert.2017.07.020","article-title":"Treatment of varicoceles: Techniques and outcomes","volume":"108","author":"D Johnson","year":"2017","journal-title":"Fertil Steril"},{"issue":"12","key":"ref10","doi-asserted-by":"crossref","first-page":"4062","DOI":"10.3390\/jcm12124062","article-title":"Varicocele: To treat or not to treat?","volume":"12","author":"A Franco","year":"2023","journal-title":"J Clin Med"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"e14259","DOI":"10.1111\/and.14259","article-title":"Effect of paternal health on pregnancy loss-A review of current evidence","volume":"54","author":"N B Brandt","year":"2022","journal-title":"Andrologia"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1002\/micr.1920050110","article-title":"Microsurgical spermaticoepigastric anastomosis for treatment of varicocele","volume":"5","author":"E Belgrano","year":"1984","journal-title":"Microsurgery"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1055\/s-0042-1750053","article-title":"Internal spermatic vein to superficial epigastric vein microsurgical bypass in varicocele treatment","volume":"33","author":"D Papes","year":"2023","journal-title":"Eur J Pediatr Surg"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"537","DOI":"10.4103\/aja2022101","article-title":"Commentary on \u201cAn alternative surgical technique for varicoceles: a preliminary experience of the microsurgical spermatic (distal end)-inferior or superficial epigastric vein anastomosis in symptomatic varicoceles associated with perineal pain\u201d","volume":"25","author":"D Papes","year":"2023","journal-title":"Asian J Androl"},{"issue":"04","key":"ref16","first-page":"CD000479","article-title":"Surgical or radiological treatment for varicoceles in subfertile men","volume":"4","author":"E Persad","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"issue":"10","key":"ref17","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1111\/j.1464-410X.2012.11093.x","article-title":"Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: A meta-analysis of randomized controlled trials","volume":"110","author":"H Ding","year":"2012","journal-title":"BJU Int"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2164\/jandrol.108.005967","article-title":"Treatment of palpable varicocele in infertile men: A meta-analysis to define the best technique","volume":"30","author":"S Cayan","year":"2009","journal-title":"J Androl"},{"issue":"10","key":"ref19","doi-asserted-by":"crossref","first-page":"3269","DOI":"10.1007\/s11255-024-04090-w","article-title":"Microscopic internal spermatic-inferior epigastric vein anastomosis for treating left varicocele","volume":"56","author":"K Dou","year":"2024","journal-title":"Int Urol Nephrol"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"624","DOI":"10.4103\/aja202232","article-title":"An alternative surgical technique for varicoceles: a preliminary experience of the microsurgical spermatic (distal end)-inferior or superficial epigastric vein anastomosis in symptomatic varicoceles associated with perineal pain","volume":"24","author":"Z Wan","year":"2022","journal-title":"Asian J Androl"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1055\/s-2003-42232","article-title":"Microsurgical spermatico-epigastric venous anastomosis in the treatment of varicocele in children: Assessment of long-term patency","volume":"13","author":"F S Camoglio","year":"2003","journal-title":"Eur J Pediatr Surg"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1055\/s-2008-1066177","article-title":"Microsurgical treatment of varicocele in adolescents","volume":"5","author":"R Luque Mialdea","year":"1995","journal-title":"Eur J Pediatr Surg"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1055\/s-2008-1071044","article-title":"The varicocele in pediatric age: 207 cases treated with microsurgical technique","volume":"7","author":"M Lima","year":"1997","journal-title":"Eur J Pediatr Surg"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/BF02551419","article-title":"Long-term results of microsurgical drainage for idiopathic varicocele","volume":"29","author":"G Flati","year":"1997","journal-title":"Int Urol Nephrol"},{"issue":"06","key":"ref25","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/S0022-5347(17)55688-8","article-title":"The varicocele syndrome: Venography determining the optimal level for surgical management","volume":"124","author":"B L Coolsaet","year":"1980","journal-title":"J Urol"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1016\/0741-5214(93)90564-3","article-title":"Iliac vein compression syndrome: an unusual cause of varicocele","volume":"18","author":"M D Bomalaski","year":"1993","journal-title":"J Vasc Surg"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"305.e13","DOI":"10.1016\/j.avsg.2016.12.001","article-title":"Left-sided varicocele as a rare presentation of May-Thurner syndrome","volume":"42","author":"J R Stern","year":"2017","journal-title":"Ann Vasc Surg"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"151","DOI":"10.2164\/jandrol.109.009258","article-title":"The evaluation of saphenofemoral insufficiency in primary adult varicocele","volume":"32","author":"H Koyuncu","year":"2011","journal-title":"J Androl"},{"issue":"09","key":"ref29","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s00247-003-0975-9","article-title":"Assessment of sapheno-femoral junction continence in patients with primary adolescent varicocoele","volume":"33","author":"M Y Karadeniz-Bilgili","year":"2003","journal-title":"Pediatr Radiol"},{"issue":"11","key":"ref30","doi-asserted-by":"crossref","first-page":"e13820","DOI":"10.1111\/and.13820","article-title":"The relationship between saphenofemoral junction insufficiency and varicocele","volume":"52","author":"E Alkan","year":"2020","journal-title":"Andrologia"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1159\/000471687","article-title":"Anatomy of the venous drainage of the human testis: testicular vein cast, microdissection and radiographic demonstration. A new anatomical concept","volume":"20","author":"M M Wishahi","year":"1991","journal-title":"Eur Urol"},{"issue":"07","key":"ref32","doi-asserted-by":"crossref","first-page":"194","DOI":"10.4329\/wjr.v3.i7.194","article-title":"Antegrade pampiniform plexus venography in recurrent varicocele: Case report and anatomy review","volume":"3","author":"V Gendel","year":"2011","journal-title":"World J Radiol"},{"issue":"06","key":"ref33","doi-asserted-by":"crossref","first-page":"2298","DOI":"10.1016\/j.juro.2012.12.030","article-title":"Pubertal screening and treatment for varicocele do not improve chance of paternity as adult","volume":"189","author":"G Bogaert","year":"2013","journal-title":"J Urol"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.juro.2017.01.066","article-title":"Paternity rates and time to conception in adolescents with varicocele undergoing microsurgical varicocele repair vs observation only: A single institution experience with 408 patients","volume":"198","author":"S \u00c7ayan","year":"2017","journal-title":"J Urol"},{"issue":"09","key":"ref35","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.3390\/jcm8091410","article-title":"Management and Treatment of varicocele in children and adolescents: An endocrinologic perspective","volume":"8","author":"R Cannarella","year":"2019","journal-title":"J Clin Med"},{"issue":"04","key":"ref36","first-page":"402","article-title":"My indications for treatment of the adolescent varicocele (and why?)","volume":"3","author":"K I Glassberg","year":"2014","journal-title":"Transl Androl Urol"},{"issue":"02","key":"ref37","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/S0022-5347(01)64567-1","article-title":"Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles","volume":"158","author":"M Sigman","year":"1997","journal-title":"J Urol"},{"issue":"07","key":"ref38","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1111\/andr.13792","article-title":"Adolescent microsurgical varicocelectomy and changes in sperm parameters: A matched cohort analysis","volume":"13","author":"F Petrella","year":"2025","journal-title":"Andrology"}],"container-title":["European Journal of Pediatric Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2770-2866.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T22:45:57Z","timestamp":1784241957000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2770-2866"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,12]]},"references-count":37,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2026,7,16]]},"published-print":{"date-parts":[[2026,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2770-2866","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0939-7248","1439-359X"],"issn-type":[{"value":"0939-7248","type":"print"},{"value":"1439-359X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12,12]]},"published":{"date-parts":[[2025,12,12]]}}}