Objective: To observe the clinical effect of High ligation of the internal spermatic vein (HLISCV) under laparoscopy and microscopy in the treatment of varicocele. Method: The clinical data of patients with varicocele who underwent microscopic HLISCV treatment in our hospital from January 2023 to December 2024 were selected and classified as the observation group (n=30). Meanwhile, the clinical data of varicocele patients who underwent L-HLISCV treatment in our hospital during the same period were selected and classified as the control group (n=30). The perioperative indicators (intraoperative blood loss, total operation time and postoperative hospital stay), sperm quality (sperm density, survival rate, forward sperm motility rate), occurrence of complications and recurrence rate of the two groups were recorded and compared. Result: Compared with the control group, the operation time of the observation group was significantly prolonged, and the postoperative hospital stay was significantly shortened (P < 0.05). There was no significant difference in intraoperative blood loss between the two groups (P > 0.05). Six months after the operation, the sperm density, survival rate and forward sperm motility rate of both groups were significantly increased compared with those before the operation, and the sperm density, survival rate and forward sperm motility rate of the observation group were significantly higher than those of the control group (P < 0.05). There was no significant difference in the incidence and recurrence rate of postoperative complications between the two groups (P > 0.05). Conclusion: Compared with L-HLISCV treatment, the microscopic surgical approach for varicocele takes longer, but the postoperative recovery is faster, the improvement effect of semen quality is better, and the safety is relatively high.