Efficacy And Safety Of Microsurgery And Laparoscopic Surgery For Varicocele: A Meta-analysis Of Trial Sequential Analysis

Objective:To systematically evaluate the curative effect and safety of microsurgery versus Laparoscopic Surgery for varicocele.Methods:Such databases as PubMed,The Cochrane Library, EMbase,VIP,CNKI, CBM and WanFang Data were searched from1990 to July 2015 for collecting the randomized controlled trials(RCT) about microscopic Varicocelectomy and laparoscopic Surgery for the treatment of varicocele,and the references of those RCTs were also searched by hand.According to the inclusion and exclusion criteria,literature was screened, data were extracted, and the level of evidence was also assessed.Then,meta-analysis was performed by RevMan 5.2 and TSA0.9 software.Results:9 RCTs were included,refers to 857 patients.The meta-analysis results showed that,compared with the laparoscopy, the microscopy had longer duration of operation,lower incidence of postoperative secondary hydrocele,lower recurrence rate,which was confirmed by TSA as the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit establishing sufficient and conclusive evidence. But there was no significant difference among postoperative testicular atrophy,duration of hospital stay and spontaneous pregnancy.Results of TSA for each outcomes of duration of hospital stay and spontaneous pregnancy demonstrated that evidence from RCTs was insufficient to draw a conclusion.Conclusion:The duration of hospital stay and spontaneous pregnancy of both group for varicocele are similar,however both of them should continue to be test;compared with the control group, the microscopy had lower incidence of postoperative secondary hydrocele and lower recurrence rate.