30 years male patient presented with a swelling in the left side of the scrotum for last 4 years. The selling started in the lower part of the scrotum and subsequently the swelling is slowly increasing in size and grown upto the root or the scrotum. The swelling disappears on lying sown position and reappears on standing and walking. Patient complains of dull aching pain in the left side of the scrotum for last 6 months. The pain is more towards the evening when the swelling is larger. There is no pain abdomen. No urinary complaints.

On examination: On inspection the left testis in lying at a lower level that the right .Multiple dilated veins are seen on the left side of the scrotum. No expansile impulse on cough is seen. On palpation a mass of dilated vein feeling like a bag of worms is palpable on the left side of the scrotum along the left spermatic cord extending from the upper pole of the testis upto the superficial inguinal ring. No expansile impulse on cough in palpable, instead a thrill is palpable. On stand up the dilated vein reappeared. The left testicular volume is smaller than the right one.Abdominal examination is normal.

Based on the above case, what is your diagnosis and what is your management ?

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