Incidence and Concurrent Laparoscopic Repair of Intra-abdominal Testis and Contralateral Patent Processus Vaginalis

Abstract

Laparoscopic orchiopexy is commonly practiced for the intra-abdominal testis. To a lesser extent, laparoscopy has offered an alternative approach to the inguinal hernia in children. We sought to determine the incidence of contralateral hernias in children with an intra-abdominal testis and to evaluate the efficacy and safety of performing concurrent laparoscopic orchiopexy and herniorrhaphy. We reviewed a single-surgeon experience with laparoscopic orchiopexy from 2001 to 2007. Boys were included in this report if they had had a concurrent open contralateral internal inguinal ring. The laparoscopic approach was used to repair the open ring and to perform the orchiopexy. Follow-up consisted of physical examinations for > or = 4 months postoperatively. A total of 64 boys (aged 8 months to 4 years) underwent laparoscopic orchiopexy for nonpalpable testes. Of these 64 boys, 7 (9.1%) had an intra-abdominal testis and a contralateral patent processus vaginalis (4 left, 3 right). Evidence of air was seen within the processus vaginalis in 5 of the 7 patients. The internal ring was closed laparoscopically concurrent with the laparoscopic orchiopexy in all 7 boys. No postoperative complications had developed after a minimal follow-up of 4 months. All cases were performed on an outpatient basis, except for 1 boy with Prader-Willi syndrome for whom it was decided preoperatively to have him stay overnight for respiratory observation. Routine inspection of the contralateral internal ring should be performed during laparoscopic orchiopexy. The incidence of an open ring in our study was about 9%. The concurrent laparoscopic repair of the hernia is not technically challenging and can be performed safely and successfully.