Laparoscopic Orchiectomy and Subsequent Internal Ring Closure for Extra-abdominal Testicular Nubbin in Children

Abstract

To present our preliminary experience with laparoscopic groin exploration and subsequent laparoscopic orchiectomy and internal ring closure for testicular nubbin in children and discuss the usefulness of our new treatment strategy. The advantages of laparoscopic orchiopexy for intra-abdominal testis are the ability to start treatment as soon as a diagnosis has been made and to permit minimally invasive surgery. These advantages can apply to laparoscopic orchiectomy for a testicular nubbin. A total of 6 boys with a testicular nubbin (age range 14-76 months, mean age 27.3 months) underwent laparoscopic orchiectomy at our institution from June 2007 to June 2008. We opened the posterior parietal peritoneum by incising the peritoneum lateral to the spermatic vessel, distal to the patent processus vaginalis and medial and distal to the vas deferens (laparoscopic groin exploration). Next, the testicular nubbin was pulled out into the abdomen and was then removed laparoscopically after identification and division of the gubernaculums. Finally, laparoscopic complete internal ring and peritoneal defect closure was performed with 5-0 Vicryl suture. The average operative time, including the diagnostic time, was 64 minutes. No intraoperative or postoperative complications developed. In 1 boy with a testicular nubbin, an open processus vaginalis was present, and simultaneous laparoscopic transection of the processus vaginalis and subsequent internal ring closure were performed. All patients with a testicular nubbin could be treated as soon as the diagnosis was made using only laparoscopic management, with minimal morbidity and good short-term results.