To evaluate the clinical efficacy and application value of gasless and gas laparoscopic surgery in the treatment of bilateral varicocele.

A retrospective analysis was performed on the clinical data of 68 patients with bilateral varicocele at the 71st Army Hospital of PLA from May 2010 to April 2016. Laparoscopic varicocele high ligation were performed on 68 patients, including 34 case who underwent gasless laparoscopic surgery accompanied by abdominal wall lifting (AWL) under combined spinal epidural anesthesia (CSEA), and 34 cases who underwent gas laparoscopic surgery under general anesthesia (GA). Changes in symptoms and signs and complications were recorded. Operative time, postoperative hospitalization time, and time to intestinal function recovery between the two groups were compared. Preoperative sperm concentration and sperm motility were compared with those at 9 months after surgery in the two groups.

All operations were performed successfully. The symptoms and signs were eased or disappeared after the operations. No serious complications occurred. Operative time, postoperative hospitalization time, and time to intestinal function recovery did not differ significantly between the two groups (P＞0.05). There was no significant difference between preoperative sperm concentration and sperm concentration at 9 months after surgery in the two groups (P＞0.05). The percentage of motile sperm at 9 months after surgery was significantly higher than that before operation [gas laparoscopy group: (78.59±6.50)% vs (74.41±6.95)%, t=6.549, P=0.013; gasless laparoscopy group: (75.88±7.47)% vs (68.71±7.43)%, t=15.770, P＜0.001].

Both gasless and gas laparoscopic surgery have the advantages of minimal invasiveness, and both are effective treatments for varicocele. Gasless laparoscopic surgery could avoid the adverse effects of pneumoperitoneum and complications related to pneumoperitoneum. CSEA as an alternative anesthesia method could have contributed to the reduction of patients' financial burden.