Varicocele is a common urological condition, usually with mild or even asymptomatic clinical symptoms, but it has received more attention in recent years because it may affect the production and development of spermatozoa. Laparoscopic treatment of varicocele is the most widely performed urological laparoscopic procedure. In this paper, we retrospectively analyzed the clinical data of 76 patients with varicocele treated by laparoscopic spermatic vein ligation. 1. Data and methods 1.1 Clinical data The Department of Urology I of our hospital admitted 76 patients with varicocele from February 2003 to April 2008, aged 15 to 55 years old, with an average age of 23+ 1 years. There were 68 cases of unilateral varicocele (89.5%) and 8 cases of bilateral varicocele (10.5%); 55 cases of moderate varicocele and 22 cases of severe varicocele. Among them, 42 cases had scrotal swelling and discomfort; 19 cases had pain as the main symptom; 15 patients had obvious abnormal semen examination, 8 cases had infertility, semen density ranged from 5 million to 18 million/ml, a+b: 8-32%, mean 19.3%. All patients underwent preoperative color Doppler ultrasonography to confirm the diagnosis and exclude secondary varicocele. Moderate to severe varicocele, significant symptoms or semen abnormalities were considered as indications for surgery. 1.2 Surgical method All 76 patients were treated with general anesthesia by tracheal intubation, and the catheter was left in the preoperative position with head down and foot up. A curved incision was made about 1 cm below the umbilical rim, and the incision was lifted with a cloth towel clamp, a pneumoperitoneum needle was inserted, a carbon dioxide artificial pneumoperitoneum was established, and the pneumoperitoneum needle was withdrawn after the pressure reached 12-14 mm Hg. A lO mm trocar was inserted, and a laparoscope was placed at an angle of 3O° to observe whether there was any damage to the intestinal canal. The blue-black spermatic vein was found above the internal ring and further confirmed by pulling the affected testis. The spermatic vein was cut along the surface of the spermatic vessels for 2-3 cm at 3 cm from the opening of the internal ring, and the spermatic vessels were freed for about 2 c m. The spermatic veins were ligated twice with a No. 4 silk. The intra-abdominal cavity was evacuated and the pressure was <5 mm Hg. The surgical field was checked again for blood leakage, and then the operating instruments were withdrawn. There was no intraoperative or postoperative hemorrhage and no surgical complications such as damage to the abdominal organs. The average hospital stay was 4 d. The follow-up period ranged from 3 to 24 months. 54 (88.5%) of the 61 symptomatic patients showed complete disappearance of symptoms and 7 (11.5%) showed significant improvement of symptoms. All patients had no abdominal discomfort; the color Doppler ultrasound showed no recurrence or testicular atrophy at 3 months after surgery. The semen quality of the 15 patients with semen abnormalities improved significantly; the sperm density increased from 5 to 20 million/ml, with an average of 10.33 million/ml, and the a+b increased from 9 to 25%, with an average of 16.4%. Among the infertile patients, three patients' spouses conceived, and the time of conception was 6, 14 and 21 months after surgery. The incidence of varicocele is 10%-15%, mostly in young adults. Long-term varicocele can increase the local temperature and hypoxia, resulting in lesions of the spermatogenic epithelial cells of the testicular varicocele, causing abnormal semen quality and infertility, which should be operated early. Most of the laparoscopic treatment uses titanium clips to close the spermatic veins, and silk ligation is rarely reported. There are some complications in the clinical application of titanium clips, such as dislodgement of titanium clips, abdominal pain caused by the retained titanium clips, abdominal abscess, arterial embolism, obstruction, stone, and the corresponding difficult cases caused by the wandering of titanium clips to rare locations. The most common and serious complication is abdominal bleeding due to dislodged titanium clips. The use of titanium clips increases the lifelong residual metal foreign body in the body, aggravates the psychological burden of the patient due to the residual foreign body, and affects the examination and treatment that may be required later. In 2001, Leng Jinhua reported a case of laparoscopic hysterectomy with intra-abdominal hemorrhage and hemorrhagic shock 2 h postoperatively, and the titanium clip was dislodged from the uterine artery section on dissection. Yang Dandong et al. observed 204 patients who underwent laparoscopic spermatic vein ligation and followed up for 6 months to 3 years. Regular Doppler ultrasound examination was performed and found good blood supply to the testes and no atrophy. There was no testicular atrophy in 1 of the 76 cases in our group after surgery, which was consistent with the results of related reports. The advantages of the wire ligation method compared with the titanium clip method are as follows: (1) the wire ligation is firm and the effect is exact; (2) less trauma, only one 10 mm poke hole is needed; (3) less complications, complications caused by the use of titanium clips can be avoided; (4) lower cost; (5) no metal remains in the body, less physiological and psychological interference to the patient; (6) does not affect and interfere with future examinations, such as magnetic resonance imaging and X-ray films. In view of the many advantages of this surgical method, it is worthwhile to promote it in clinical practice.