Laparoscopically Assisted Correction Of Transverse Testicular Ectopia

Abstract

Transverse testicular ectopia or crossed testicular ectopia is a well described congenital anomaly in which the 2 testes descend through a single inguinal canal. The usual clinical presentation is an impalpable testis on 1 side and a normally descended testis with symptomatic inguinal hernia on the contralateral side. The patient often undergoes unsuccessful inguinal exploration and the ectopic testis is usually discovered operatively during herniotomy. CASE REPORT A 2-year-old boy was referred in May 1998 for evaluation of an impalpable right testis after negative inguinal exploration was performed elsewhere. Physical examination demonstrated a right inguinal incision with a nonpalpable testis. The left hemiscrotum was remarkable for a communicating hydrocele. Left communicating hydrocele repair was planned with diagnostic laparoscopy through the patent processus vaginalis. When the tunica vaginalis was opened, a tubular structure was noted running from the testis more proximal into the peritoneal cavity. Careful traction on this structure revealed a contralateral intra-abdominal testis, which was present in crossed, fused fashion (see figure). With this entity identified laparoscopic entry was achieved via a 5 mm. umbilical port. The gubernaculum connecting the 2 testes was divided. A right inguinal incision was made and a Kelly clamp was passed through it under laparoscopic guidance. The crossed testis was then grasped at the site of the gubernaculum and passed to the contralateral inguinal ring. Standard right orchiopexy was performed using a subdartos pouch. Notably generous cord length on this side obviated the need for a Fowler-Stephens procedure. Long-term followup confirmed 2 healthy testes in their respective orthotopic locations. DISCUSSION