Objective To evaluate the effectiveness and safety of microsurgical varicocelectomy (MV) compared with Palomo surgery for male varicocele. Methods MEDLINE (1985-October 2008), EMbase (1990-October 2008), China Biology Medicine Literature Disc Database (1979-October 2008), CMCC (1979-October 2008) and CNKI (1990-October 2008) were searched electronically by computer. Addtionally, four relevant journals were searched manually to get randomized controlled clinical trials about the comparison of MV and Palomo in the treatment of varicocele. Two reviewers screened the literature, evaluated the document quality, extracted the data independently, and checked the result together. RevMan software version 4.3.1 developed by the Cochrane Collaborative was used for meta-analysis. Results Seven RCTs reporting data on effectiveness and safety of MV versus palomo surgery were included. Meta-analyses showed that MV was superior to palomo surgery in improving sperm motility [RR= 1.21, 95%CI (1.09, 1.34), P=0.000 5], concentration [RR= 1.35, 95%CI (1.20, 1.51), Plt;0.000 01] and also postoperation natural pregnancy rate [RR= 1.34，95%CI (1.08, 1.66), P=0.008]. While the MV group had a longer operation time in unilateral [WMD= 23.01 min, 95%CI (16.86, 29.16), Plt;0.000 01] or bilateral varicocele [WMD= 34.05 min, 95%CI (4.9, 63.21), P=0.02] than Palomo surgery. The recovery time difference in the two groups was not significant. The incidence of varicocele recurrence was significantly lower in the MV group than in the Palomo group [RR= 0.17, 95%CI (0.10, 0.31), Plt;0.000 01], and the incidence of postoperative hydrocele was also significantly lower in the MV group than in the Palomo group [RR= 0.10, 95%CI (0.05, 0.23), Plt;0.000 01]. The incidences of wound infection, scrotal hematoma and scrotal pain were similar in both groups. Conclusion The evidence shows that MV is superior to Palomo surgery because of the higher sperm improvement rate, higher natural pregnancy rate and lower incidence of recurrence and hydrocele. But the operation time is longer. The long-term effect and overall effectiveness of MV need more high-quality RCTs to confirm.