The key to determine the effect of spermatic cord ligation is whether the spermatic artery can be found and all the veins can be ligated, because there are three components in the spermatic cord: the spermatic vein (can be one or more), the testicular artery (usually one) and the lymphatic vessels, finding and preserving the artery and ligating all the veins is the best surgical result, preserving the artery, ensuring the blood supply to the testes and through the external spermatic veins. The best result is to preserve the artery, which ensures the blood supply to the testis and the return flow through the external spermatic vein. Ligation of all the internal spermatic veins blocks the return of metabolic wastes such as catecholamines and 5-hydroxytryptophan in the renal venous blood, restoring the normal blood supply to the testes and the epididymis in order to restore testicular function to the greatest extent. Regarding recurrence, the internal spermatic vein is a venous plexus in the scrotum, which converges into 1-2 branches in the inguinal canal and continues upward in the retroperitoneum, and the left internal static vein enters the left renal vein at right angles. Therefore, theoretically, the possibility of complete ligation of all the internal veins of the spermatic cord is the greatest in retroperitoneal surgery. However, in practice, it is found that in most cases more than two spermatic veins are found during retroperitoneal surgery, and there may be some tiny veins that cannot be identified by the naked eye, or they may not be detected during surgery because they are surrounded by lymphatic vessels, or they are close to the arteries and not easily detected. Therefore, there is a possibility of missing a vein during the surgery, and if there is a missed vein, there is a possibility of recurrence. Generally speaking, the key to recurrence after surgery is whether all the internal spermatic veins are ligated during surgery. If there is a residual internal spermatic vein, there is a possibility of recurrence after surgery. The ultrasound is usually repeated after 6 months after surgery to determine if there is recurrence. ”Microscopic spermatic vein high ligation”, after finding the spermatic cord and magnifying it about 10 times with a microscope, it is easy to identify: testicular artery, internal spermatic vein and lymphatic vessels, the artery should be preserved, all internal spermatic veins should be ligated, and all lymphatic vessels should be preserved. Ligation of all veins ensures that varicocele does not recur after surgery, preservation of testicular artery ensures adequate arterial blood supply to the testis, and preservation of all lymphatic vessels ensures smooth lymphatic return to avoid scrotal edema and sphingomyelia after surgery. It is not necessary to dissect the levator muscle, which can avoid damage to the external spermatic vein and the arteries and veins of the vas deferens, and is conducive to the establishment and recovery of the collateral circulation after surgery. It is currently the best surgical option for the treatment of varicocele.