✦ Varicocele Treatment

High Retroperitoneal Ligation (Palomo)

Q: Is the testicular artery always sacrificed in the Palomo procedure?

In the original Palomo technique yes; modified artery-sparing Palomo attempts to preserve the artery but requires careful dissection. Your consultant will provide specific guidance based on your individual clinical situation and recovery.

Q: What is the risk of testicular atrophy?

Testicular atrophy risk is 1–5% after Palomo procedure; collateral blood supply via the vasal artery usually maintains testicular function.

Q: Why is Palomo used less often now?

Microsurgical varicocelectomy with preserved artery and lymphatics has lower recurrence, hydrocele, and atrophy rates — replacing Palomo in most centres.

High Retroperitoneal Ligation of Testicular Veins for Varicocele

30–60 min PROCEDURE

Day Care / 1 Day HOSPITAL STAY

>85% SUCCESS RATE

1–2 Weeks RECOVERY

What is High Retroperitoneal Ligation (Palomo)?

The Palomo procedure is a high retroperitoneal approach to varicocele repair in which the internal spermatic artery and all accompanying veins are ligated together high above the internal inguinal ring through a small suprainguinal incision. By ligating the entire vascular bundle before arterial branching occurs, it reduces the risk of missed veins but carries a higher risk of testicular atrophy and hydrocele formation compared to artery-sparing techniques. The procedure is performed under general or spinal anaesthesia with a hospital stay of Day Care / 1 Day.

Men with varicocele in paediatric practice, recurrent varicocele after prior ligation, or settings where vessel-sparing microsurgical techniques are unavailable. Patients must be adequately fit for anaesthesia and free from active systemic infection before proceeding.

How the Procedure Works

Incision & Access

Small incision made 3–4 cm above and medial to the internal inguinal ring.

Retroperitoneal Entry

Retroperitoneal space entered; internal spermatic vessels identified high above the ring.

Vessel Ligation

All internal spermatic vessels — artery and veins — ligated together as a bundle.

Wound Closure

Wound closed; testicular blood supply maintained through collateral vasal vessels.

Recovery

Scrotal support applied; patient discharged same day.

Outcomes

30–60 minDURATION

Day Care / 1 DayHOSPITAL STAY

>85%SUCCESS RATE

1–2 WeeksFULL RECOVERY

Who Needs This Treatment?

→Simple technique with no requirement for microsurgical skill or equipment.
→High success rate due to mass ligation of all spermatic vessels.
→Suitable for paediatric varicocele repair.
→Effective for recurrent varicocele when lower approaches have failed.
→Short operation time with rapid recovery.
→Testicular blood supply maintained via collateral vasal and cremasteric vessels.

"The Palomo procedure is technically simple and effective, particularly in paediatric practice. While modern microsurgery has refined our approach, high retroperitoneal ligation remains a valid option in the right context."

— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon

Common Questions

Frequently Asked

Is the testicular artery always sacrificed in the Palomo procedure?+

What is the risk of testicular atrophy?+

Why is Palomo used less often now?+

Not sure which treatment is right for you?

Book a consultation with Dr. Vipin Reddy and get a personalised treatment plan.

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