Background: Varicocele is one of the most common surgically correctable causes of male infertility, affecting approximately 15% of the general male population. It is detected in nearly 35% of men with primary infertility and up to 81% of those with secondary infertility. Several operative techniques are currently available for varicocele repair, including open and laparoscopic approaches.Aim: To compare open bilateral subinguinal varicocelectomy and laparoscopic bilateral varicocelectomy regarding operative time, clinical outcome, seminal fluid analysis, postoperative complications, operation-related pain, hospital stay, and return to normal activity.Patients and Methods: This prospective comparative study was conducted at the Urology Department of Al-Imamain Al-Kadhymain Medical City from January 2015 to August 2016. A total of 63 male patients with bilateral varicocele were enrolled and divided into two groups. Group I included 30 patients who underwent open bilateral subinguinal varicocelectomy, whereas Group II included 33 patients treated with laparoscopic bilateral varicocelectomy. Clinical assessment, semen analysis, operative time, postoperative complications, pain score, hospital stay, and return to normal activity were evaluated and statistically analyzed.Results: The mean age was 28 ± 8 years in the open surgery group and 25 ± 7 years in the laparoscopic group. Operative time was significantly shorter in the laparoscopic group (45 ± 9 minutes) compared with the open group (50 ± 20 minutes) (P < 0.05). Operation-related pain was significantly lower in the open surgery group (2.8 ± 1.2) compared with the laparoscopic group (4.1 ± 1.3) (P < 0.05). Improvement in semen analysis was observed in both groups without statistically significant differences (P > 0.05). Most patients had no postoperative complications. The mean hospital stay was one day in both groups, and no significant difference was found regarding return to normal activity.Conclusion:Both open bilateral subinguinal varicocelectomy and laparoscopic bilateral varicocelectomy are effective and safe techniques for bilateral varicocele treatment. Laparoscopic surgery offers shorter operative time and faster recovery, whereas open surgery is associated with lower postoperative pain.