CPT® Code 55535

1. Indications

The procedure described by CPT® Code 55535 is indicated for the treatment of a varicocele, which may present with various symptoms or conditions. The following are explicitly provided indications for performing this procedure:

• Varicocele: An enlargement of the veins in the scrotum that may cause discomfort or pain.
• Infertility: A varicocele may be associated with male infertility, necessitating surgical intervention to improve fertility outcomes.
• Testicular Atrophy: The presence of a varicocele can lead to testicular shrinkage, which may warrant surgical correction.
• Scrotal Pain: Patients experiencing chronic pain in the scrotal area may benefit from the excision or ligation of the affected veins.

2. Procedure

The procedure for CPT® Code 55535 involves several detailed steps, which are outlined as follows:

• Step 1: A skin incision is made along the line of Langer in the lower abdomen, allowing access to the underlying tissues. The incision is carried down through the subcutaneous tissue until the external oblique aponeurosis is reached.
• Step 2: The muscle fibers of the external oblique are incised, and the ilioinguinal nerve is identified and isolated to prevent nerve damage during the procedure.
• Step 3: The internal oblique muscle is exposed, and blunt dissection is performed to reveal the transverse abdominis muscle, which is then transected to gain access to the retroperitoneal space.
• Step 4: The retroperitoneal space is entered just above the inguinal ligament, allowing for the medial displacement of the peritoneum to expose the testicular artery and vein, as well as the femoral artery and inferior epigastric artery and vein near the vas deferens.
• Step 5: The vessels are elevated using a loop, and a solution of 1% Papaverine may be used for irrigation to induce dilation and pulsation, facilitating the identification of the arteries and veins.
• Step 6: The veins, arteries, and lymphatic vessels are identified, and the spermatic veins are ligated using vascular clips or intracorporeal sutures to prevent blood flow through the varicocele.
• Step 7: Alternatively, if necessary, the varicocele may be excised to remove the enlarged veins completely.
• Step 8: Hemostasis is achieved using electrocautery to minimize bleeding during the procedure.
• Step 9: Finally, the incision is closed in layers to ensure proper healing and minimize scarring.

3. Post-Procedure

After the completion of the procedure, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, instructions for activity restrictions, and follow-up appointments to assess recovery. Patients are advised to avoid strenuous activities and heavy lifting for a specified period to promote healing. Additionally, any signs of infection or unusual symptoms should be reported to the healthcare provider promptly. The expected recovery time may vary based on individual circumstances, but most patients can return to normal activities within a few weeks, depending on their overall health and the specifics of the surgical intervention.