[61] Surgical management of pain as a complication of radio-embolisation of varicocoele

Objective To present our experience of surgical management of pain as a complication of radio-embolisation of varicocoele. The indication to treat a painful varicocele is well established; however, the approach of treatment whether surgical or radiological remains controversial. The use of materials such as coils during radio-embolisation may lead to exacerbation of pain, which might require surgical removal of the endovascular material. Methods All patients between March 2016 and February 2017, who experienced painful exacerbation after radio-embolisation of a varicocoele, were included in this retrospective single-centre study. Ultrasonography was performed to exclude recurrence or other aetiology. A transperitoneal laparoscopic surgical procedure allowed removal of embolisation material and gonadal vein after ligation between the internal inguinal ring and its distal end on the renal vein or inferior vena cava. Results Three patients were operated upon using this technique. Two patients had unilateral left and one bilateral varicocoeles with radio-embolisation. No intraoperative complications were identified. The intervention reduced the pain allowing early recovery and continuation of usual daily activities. Conclusion The exacerbation of pain in a varicocoele after radio-embolisation is a rare complication but has significant consequences on patient quality of life and thus requires appropriate care. Removal of the material laparoscopically seems a method of choice. The elimination of other painful causes before any surgical management remains essential.