Introduction: Microsurgical varicocelectomy is the gold standard for varicocele therapy because it has a higher success rate and minimal complication rate than other surgical modalities. This review aims to directly compare the efficacy and safety of inguinal and subinguinal varicocelectomy microsurgery. Method: This study conducted based on Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Articles examining the comparison of inguinal micro-varicolectomy compared to subinguinal in patients with varicoceles undergoing varicocele surgical procedures were systematically reviewed from the PubMed, ScienceDirect, and Scopus databases. Randomized Controlled Trials (RCT) studies’ quality was determined using the RoB Tool v2: for randomized trials. Risk Ratio with a 95% confidence interval is applied to the measurement of research outcomes. The analysis is performed with RevMan 5.4 software. This research protocol is listed in the PROSPERO register. Result: A total of 293 study subjects were included from three articles in the study. Inguinal micro-varicocelectomy has a faster operating time outcome than the subinguinal approach (MD:-3.81 95% CI-6.41-1.21; p = 0.004) but has a higher postoperative visual analog pain scale (VAS) outcome (MD:-0.44 95% CI 0.85-0.03; p = 0.03). Conclusion: There were no significant differences in the outcome of hydrocele incidence, the degree of recurrence, or the number of veins that were ligated after surgery. Micro-varicocelectomy with the inguinal approach has the advantage of faster operating time than the subingunal approach but has a higher pain rate than the subinguinal approach. We suggest the sub-inguinal rather than inguinal approach because of the higher number of benefits.