SUMMARY Aim: To describe the surgical technique and present outcomes of the first 20 boys and adolescents that underwent microsurgical varicocelectomy at the Department of pediatric surgery, University Hospital Center Zagreb. According to the literature data, this method has the lowest incidence of recurrence and complications. Patients and Methods: Indications for microsurgical varicocelectomy are the same as for other methods of varicocele treatment: presence of symptoms, testicular hypotrophy (affected testicle smaller >20% in volume compared to the contralateral testicle), or abnormal semen analysis in adolescent that reached the final (Tanner 5) stage of pubertal development. The diagnoses of varicocele and testicular hypotrophy were established by clinical examination, ultrasound volumetry and Doppler examination. The surgery was done through a 3–4 cm incision above the external inguinal ring. The patients were followed prospectively, with an average follow-up of 10 months (range 6–12 months). Results: Average surgery duration was 65 minutes. All patients were discharged within 24 hours after surgery, and returned to all preoperative activities within two weeks postoperatively. No recurrences were noted during follow-up, symptoms resolved in all patients operated for symptomatic varicocele, and sperm count normalized in all patients that underwent surgery for abnormal semen analysis. Regarding complications, one patient reported a transitory discomfort during ejaculation. In one patient the testicular artery was inadvertently ligated during surgery, but was immediately reconstructed with an end-to-end anastomosis. Control Doppler examinations of the spermatic cord showed a patent anastomosis with normal flow. Conclusion: Microsurgical varicocelectomy is a safe method for varicocele treatment with a high success rate and low incidence of complications.