Role of Laparoscopic Hernia Repair in Men With a Previous Negative Inguinal Exploration for a Cryptorchid Testicle

Abstract

To evaluate the role of laparoscopy in adults presenting with indirect inguinal hernias with a previous negative inguinal exploration for nonpalpable testes in childhood who were diagnosed with a vanishing testis. We present a case report of an individual who underwent a negative inguinal exploration in childhood for a nonpalpable testis. During laparoscopic repair of the defect, an intra-abdominal testicle was discovered. This was the basis for a literature search for the role of laparoscopy in adults with nonpalpable testes. A MEDLINE and PubMed online literature search was performed from 1980 to present. Search words such as adult nonpalpable testis, cryptorchidism, vanishing testis, and laparoscopy were used. Ten articles were found detailing the role of laparoscopy in the management of undescended testes in adult patients. When a patient presents with an indirect hernia and a history of inguinal exploration for an impalpable testicle and there is no clear prior negative inguinal exploration for a nonpalpable testis, laparoscopy has an important role in further evaluation of the patient. Owing to the risk of malignancy in the undescended testis and risk for subfertility, patients evaluated during the prelaparoscopic era need to have the diagnosis of an absent testis confirmed or refuted. Laparoscopy is a safe, effective, and sensitive procedure for evaluating and treating nonpalpable testes in adults.