Abstract
BackgroundDiscuss the superiority of laparoscopic orchiopexy in the treatment of inguinal palpable undescended testes.MethodsInclusion criteria: Preoperative examination and color Doppler ultrasound examination confirmed that the testes were located in the inguinal canal and could not be pulled into the scrotum, except for retractive and ectopic testes. The surgical steps were depicted as follow. The retroperitoneal wall was carved by ultrasonic scalpels, separates the spermatic vessels closed to the inferior pole of the kidney if necessary, dissects the peritoneum of vas deferens, cuts the testicular gubernaculum, and pulls back the testicle into the abdominal cavity. Besides, protect the vas deferens, and descend the testes to the scrotum and fix them without tension.ResultsThere were 773 patients with 869 inguinal undescended palpable testes, 218 cases on the left side, 459 cases on the right side and 96 cases with bilateral undescended testes, whose age ranged from 6 months to 8 years, with an average of 20 months. All testes were successfully operated, no converted to open surgery. The average operation time was (34.8 ± 5.4) min. There were 692 testes have an ipsilateral patent processus vaginalis (89.5%); In 677 cases of unilateral cryptorchidism, 233 cases (34.4%) have a contralateral patent processus vaginalis, and laparoscopic percutaneous extraperitoneal closure the hernia sac carry out during the surgery. There was no subcutaneous emphysema during the operation, no vomiting, no abdominal distension, no wound bleeding and obvious pain after surgery, especially wound infection is rarely. Doppler ultrasound was evaluated regularly after surgery. The patients were followed up for 6 to 18 months. All the testes were located in the scrotum without testicular retraction and atrophy. No inguinal hernia or hydrocele was found in follow-up examination.ConclusionLaparoscopic orchiopexy manage inguinal palpable cryptorchidism is safe and effective, and there are obvious minimally invasive advantages. Furthermore, It could discover a contralateral patent processus vaginalis, and treat at the same time, which avoid the occurrence of metachronous inguinal hernia.
Highlights
Discuss the superiority of laparoscopic orchiopexy in the treatment of inguinal palpable undescended testes
It is well known that inguinal hernia is a common concomitant complication of cryptorchidism, the research [8, 9] reported approximately 64–92% of cryptorchidism with ipsilateral patent processus vaginalis, fewer literature [9] focus on the relationship between inguinal palpable cryptorchidism with contralateral patent processus vaginalis, which could develop into metachronous inguinal hernia
The paramount purpose of this study was to discuss the superiority of laparoscopic orchiopexy in the treatment of inguinal palpable undescended testes, secondly, confirm the incidence of inguinal palpable testis associated with a contralateral patent processus vaginalis discovered during laparoscopy
Summary
Discuss the superiority of laparoscopic orchiopexy in the treatment of inguinal palpable undescended testes. Cryptorchidism, or undescended testes, is not uncommon in children’s congenital malformations. This condition usually involves the testicle failing to move from the abdomen through the inguinal canal to the scrotum during fetal development. Laparoscopy has been widely used to diagnose and treat intra-abdominal cryptorchidism, while it is still controversial for the treatment of inguinal cryptorchidism that can touch the testis [1], the classical surgical approach is trans-inguinal orchiopexy, there are some flaws in this surgical procedure [2,3,4]. Since Decimo et al [5] firstly introduced laparoscopic orchiopexy for the high palpable undescended testis, some studies [6, 7] began to explore laparoscopy for treatment of inguinal cryptorchidism, pointed out that the laparoscopic technique is safe and feasible, no large amount of cases have been reported. It is well known that inguinal hernia is a common concomitant complication of cryptorchidism, the research [8, 9] reported approximately 64–92% of cryptorchidism with ipsilateral patent processus vaginalis, fewer literature [9] focus on the relationship between inguinal palpable cryptorchidism with contralateral patent processus vaginalis, which could develop into metachronous inguinal hernia
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