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Abstract

BACKGROUND: Varicocele, common cause of male infertility, negatively affects semen parameters like sperm count and motility. Surgical intervention, specifically varicocelectomy, remains a key treatment strategy, with laparoscopic, open and microscopic sub-inguinal techniques widely practiced. However, comparative data specific to open techniques, traditional and microscopic to the Peshawar region remains limited.
OBJECTIVE: This study aimed to compare the impact of microscopic versus non microscopic open sub-inguinal varicocelectomy on sperm parameters, evaluating postoperative improvements and complication rates among patients in a tertiary care setting.
METHODOLOGY: A quasi-experimental study was conducted at Northwest General Hospital, Peshawar, enrolling 220 male patients with clinically diagnosed varicocele. Patients were divided into two groups: Group A underwent microscopic sub-inguinal varicocelectomy (n=110), and Group B received the non-microscopic open subinguinal varicocelectomy technique (n=110). Pre- and postoperative semen analyses were performed, and data were statistically analyzed using SPSS v22.
RESULTS: Group A showed significantly greater improvements in sperm count (from 14 ± 0.68 to 39 ± 7.4 million/mL) and motility (from 23 ± 3.75% to 58 ± 12.32%) compared to Group B (count: 12 ± 2.28 to 30 ± 5.7 million/mL; motility: 21 ± 5.34% to 53 ± 8.73%).  ≥50% improvement in semen parameters was achieved in 53.63% of Group A, versus 39.09% in Group B (p = 0.0426). Although statistically non-significant, postoperative complications were fewer in the microscopic group.
CONCLUSION: Microscopic varicocelectomy provided superior improvement in semen parameters and fewer complications than the non-microscopic open subinguinal varicocelectomy technique. The findings support broader adoption of microsurgical approaches in fertility management, particularly in resource-limited settings.
KEY-WORDS: Varicocelectomy, Microscopic Surgery, Sperm Parameters, Male Infertility, Sub-Inguinal Approach.