Comparison of Laparoscopic Varicocelectomy and Microsurgical Varicocelectomy with Internal Spermatic Vein-Superficial Epigastric Vein Bypass in Adolescent Patients

Background/Objectives: Varicocele is a common cause of testicular hypotrophy and impaired semen quality in adolescents. Laparoscopic varicocelectomy (LV) and microsurgical varicocelectomy (MV) with internal spermatic vein-superficial epigastric vein bypass are established treatment options. This study aimed to compare clinical outcomes, complication rates, and functional recovery between LV and MV in adolescents. Methods: A retrospective two-center analysis was conducted on adolescents who underwent LV or MV between 2019 and 2024. Primary outcomes included postoperative complications, recurrence, testicular volume recovery, and semen parameter improvement. Secondary outcomes included operative time, hospital stay, and return to full activity. Statistical significance was set at p < 0.05. Results: A total of 430 patients met the inclusion criteria (270 LV, 160 MV). LV had a significantly shorter operative time (15 ± 5.1 min vs. 55.5 ± 6.4 min; p < 0.0001). There were no significant differences in hospital stay (p = 0.28), postoperative hematoma (p = 0.06), hydrocele (p = 0.06), or recurrence rates (p = 0.20). Full recovery of testicular volume occurred in 75.0% after LV vs. 70.6% after MV (p = 0.40). Overall semen improvement was 89.5% in LV vs. 100% in MV (p = 0.07). Normalization of oligospermia was significantly higher in the MV group (92.8% vs. 65.3%; p = 0.0048). Conclusions: Both LV and MV are safe and effective techniques for adolescent varicocele repair, with comparable complication and recurrence rates. LV offers significantly shorter operative time, whereas MV provides a superior improvement in semen parameters, suggesting a potential advantage of microsurgical repair in adolescents presenting with abnormal semen analysis.