الفهرس 
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Abstract
A Vricocele consist of elongated, dilated and tortuous spermatic veins within the pampiniform plexus. It is the most common cause of male infertility and it is a surgically correctable or at least improvable form of infertility.
The incidence of varicocele in general population is about 15%, while in infertile men the incidence between 19 and 41%. In men with secondary infertility, the incidence is as high as 70-80%. The left side is affected in 95% of cases.The etiology of varicocele is probably multifactorial. Several factors are considered as possible causes for development of varicocele and its predominance on the left side: 1. Longer left internal spermatic veins.
2. The proximal nutcracker effect with compression of the left renal vein between the aorta and superior mesenteric artery.
. . 3. Incompetent valves
4. Left adrenal venous flow into the LRV opposite the confluence of the left spermatic vein.
5. The distal nutcracker with compression the left common iliac vein by the left common iliac artery.
The pathophysiology of varicocele infertility has not been delineated but there are many theories that may explain the pathophysiological changes that can occur with varicocele which include:
. Increase testicular temperature.
. Nuclear DNA damage and high oxidative stress.
. Endocrine abnormalities.
. Elevated nitric oxide.
. Testicular atrophy.
. Leydig cell dysfunction.
. Altered blood flow.
. Formation of antispermatozoal antibodies.
Varicocele is diagnosed by the following: clinically the patient is complaining of either pain or fertility problems or discrepancy of the testicular size, varicocele is diagnosed mainly by physical examination where the palpable varicocele has been described as feeling like a bag of warms at the scrotal neck. Varicocele grades are defined as follow:
. Grade I; palpable only with valsalva.
. Grade II: palpable without Valsalva.
. Grade III: visible.
The following investigation done to diagnose varicocele and its effect on the fertility: Radiological as scrotal ultrasonography( Doppler, high resolution ultrasound, color coded duplex), venography, scrotal thermography and semen analysis.
The main goal of treatment of varicocele is preservation of fertility; a varicocele should be corrected when there is one of the following;
. It is clinically palpable.
. Infertility.
. Dragging testicular pain.
There are different surgical methods of treatment of varicocele either by open surgical approaches which include scrotal approach, retroperitoneal or high ligation approach, inguinal approach, subinguinal approach, microsurgical inguinal and subinguinal approach and laparoscopic approach.
This study included 15 patients with clinical left sided and bilateral varicocele presenting with either primary infertility, chronic scrotal pain or both.
All patients were underwent laparoscopic varicocelectomy with dye assisted lymphatic sparing using trypan blue. The aim of the study is to detect the effectiveness of lymphatic sparing on the rate of postoperative complications as hydrocele, postoperative pain and testicular size. Also to detect the effectiveness on the degree of improvement of the parameters of semen analysis.
IN conclusion:
.Varicocelectomy is recommended for all patient with primary infertility with any semen abnormality as there is significant improvement occur in all semen parameters after varicoceletomy.
. Laparoscopic varicocelectomy has many advantages as, decrease operative time, postoperative hospital stay, decrease pain, early return to work and better outcome due to good visualization of lymphatic and vessels. In addition to detect intrabdominal pathology. It is also, very suitable for the bilateral cases as it approach the varicocele from the same ports sites.
. The most successful method of prevention of postoperative hydrocele formation after a laparoscopic Palomo’s procedure seems to be intraoperative lymphatic staining and the preservation of lymphatic vessels. In addition it minimizes the risk of postoperative testicular dysfunction, scrotal edema and scrotal hematoma and decrease the rate of varicocele recurrence