This paper reports the management of a case of suspected failure of varicocele surgery. The patient had bilateral varicocele (Ⅲ degree on the left and Ⅱ degree on the right) with local pain and discomfort and severe abnormal semen quality, and underwent laparoscopic bilateral high level ligation of spermatic veins. After clinical and laboratory examination, the patient was found to have no clear evidence of surgical failure, and symptomatic treatment was chosen to avoid reoperation. The patient’s clinical manifestations (syringomyelia and swelling) were reduced, and the quality of semen improved in laboratory tests. In this case and in the literature, we suggest that the indications for reoperation should be strictly controlled: clear signs of recurrence (posture-related varicocele and blood reflux); the patient’s original complaints (pain and discomfort, abnormal semen quality) are still present and not improving. If it is difficult to determine, observation and waiting is recommended to avoid unnecessary reoperation. Usually, the patient should be observed for 3 to 6 months after surgery before making a comprehensive decision.