Laparoscopic Orchidopexy without Division of Spermatic Vessels using a Neoinguinal Canal Approach: A Single Center Experience

Abstract

Introduction: About 1 to 2% of boys at age of 1 year have an undescended testis (UDT); almost 20% of UDT are nonpalpable. Several surgical procedures have been described but there are no formal guidelines for the management of boys with nonpalpable testis. We report our experience with laparoscopic orchiopexy performed without dividing the spermatic vessels in this case series over a period of 4 years stating that the Fowler-Stephens technique is no longer indicated for the treatment of the intra-abdominal testis. Materials and methods: Over a period of 7 years from 2005 to 2012, we carried out diagnostic laparoscopy on 50 nonpalpable intra-abdominal testis in 45 boys followed by laparoscopic orchiopexy without sectioning the spermatic vessels even in cases where testis was higher up (30 cases). The technique consisted in sectioning the gubernaculum, opening the peritoneum laterally to the spermatic vessels, and mobilizing the testicular vessels and the vas deferens in a retroperitoneal position for 8 to 10 cm. The testis was then brought down into the scrotum through a neo-inguinal ring created just lateral to medial umbilical ligament. Results: Out of 45 cases with 50 undescended testis, 30 testes were abdominal, away from the internal ring out of which we were able to bring 28 testis in the scrotum without dividing the spermatic vessels, using a neo-inguinal ring. The other two patients had to undergo orchidectomy because of atretic testis. In the remaining 20 cases, the testis was at the inguinal ring or close to it and mobilized easily through the neo-inguinal ring to scrotum. The mean follow-up period has been 14 months (6 months to 2 years) and all the testes were found to be in scrotum with no atrophy. Conclusion: On the basis of our experience, we believe that laparoscopic orchiopexy without division of the spermatic vessels should be the treatment of choice in the management of nonpalpable testes because it does not compromise the normal testicular vascularization. Creation of neo-inguinal canal lateral to the medial umbilical ligament has the advantage of gaining more length on the vessels and vas to bring the testis to scrotum and hence Fowler-Stephens procedure is no longer routinely indicated in management of high abdominal testis.