Complications of varicocele surgery Whether open surgery or laparoscopic surgery for varicocele, complications may occur, the main common ones are: 1. Scrotal effusion or testicular sphincter effusion: Scrotal edema and testicular sphincter effusion are the most common complications after surgery, the incidence is between 3% and 40%. It is widely believed that the mechanism of scrotal edema is related to the injury of lymphatic vessels. The lymphatic vessels accompanying the spermatic artery are damaged during surgery, resulting in extravasation of lymphatic fluid and obvious local edema, while the veins have been ligated and the reflux is obstructed, and testicular syringomyelia can occur in severe cases. 2, testicular atrophy: the incidence of testicular atrophy is about 0.2%. Testicular artery injury is an aspect of the Palomo procedure that is difficult to avoid. The main reason is that the testicular artery is ligated, resulting in a dramatic decrease in testicular blood supply and thus ischemic atrophy. However, most scholars believe that there are abundant anastomotic branches between the internal spermatic artery, the vas deferens artery and the levator artery, and even if the testicular artery is mistakenly ligated, the latter two branches are sufficient to provide sufficient blood supply to the testis without serious consequences. inguinal nerve, genitofemoral nerve, and the almost unmentioned superior and inferior spermatic nerves. The incidence of genitofemoral nerve injury during transcatheter laparoscopic surgery for varicocele ranges from 2% to 9%, with symptoms presenting as temporary numbness in the anteroinferior thigh and anterolateral aspect of the surgical incision, usually occurring 0 to 10 d (mean 3 d) after surgery, with symptoms maintained for an average of approximately 8 months. Injury to the inguinal nerve of the ilium has not been precisely reported in the literature as the superior and inferior spermatic nerves were raised during microsurgery, and some studies have pointed out that injury to these nerves may lead to apoptosis of spermatogenic cells. 4, vas deferens injury: vas deferens injury is a theoretical complication of varicocele surgery, because during surgery, the vas deferens is white, tough to the touch, tubular in structure, clearly distinguished from the color and structure of the surrounding blood vessels and other tissues, and any urologist and male physician can correctly identify and separate it to avoid unintentional clamping. 5. Acute epididymitis: Acute epididymitis after surgery is related to ligation or injury to testicular artery, because testicular artery is easy to be injured during surgery as it is accompanied by intravenous spermatic cord. After the injury, the epididymis and testis, which are already in hypoxia and metabolic disorder, are further aggravated by hypoxia before the establishment of compensatory blood vessels, and the resistance is further reduced, so that infection can easily occur. Patients with this disease mainly present with swelling and tenderness of the affected scrotum, enlarged epididymis with unclear borders, and fever 5-10 days after surgery. 6. Omental emphysema and scrotal emphysema: scrotal emphysema and omental emphysema are complications specific to laparoscopic surgery and are related to the establishment of the pneumoperitoneum but not to varicocele spermatic vein ligation itself. In addition, there are other rare complications, such as postoperative low back and testicular pain, which may be related to the anatomical structure of the spermatic cord itself, and excessive stretching of the spermatic cord during surgery can cause discomfort in the renal region; injuries to abdominal and pelvic organs during surgery, such as the intestinal canal and bladder, are mostly caused by poor surgical practice or unfamiliarity with anatomy; occasionally, injuries to femoral vessels, such as the femoral artery and femoral vein, are mostly caused by the surgeon’s unfamiliarity with the inguinal unfamiliar with the anatomical level, or excessive lateral pulling by the assistant, deviating from the tendon membrane of the external oblique abdominal muscle and entering the femoral ring during surgery; or combined with extra-abdominal hernia; infection of the incision (including the umbilicus), associated with lax aseptic operation. Therefore, clinicians should pay attention to prevention and appropriate management, and patients and families should be informed of the risks and possible complications of surgery before surgery.