Palomo procedure (retroperitoneal, high ligation of the internal spermatic vein without preserving the testicular artery) – performed in 68% of their pediatric cases. They acknowledged a risk of testicular atrophy (4-6%) but considered it acceptable.
Ivanissevich procedure (similar to Palomo but with artery preservation attempted) – used in 24% of cases with better outcomes but higher recurrence (9% vs 3% for Palomo).
Endoscopic ligation – mentioned as experimental in 1982; not routinely available in the Okrug region.