[Which laparoscopic technique is the best to descend intra-abdominal testes?] Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica [Cir Pediatr] Journal article

INTRODUCTION: It's reported that the laparoscopic orchiopexy without vessel transection at one stage (LO1S) is the recommended technique for the testis located near to the internal ring (IR) and orchiopexy in two stages according to Fowler Stephens (2SFSO) for the testicles located far away to the IR .The dilemma arises in those testicles situated on the border between the two procedures. We reported our experience in the management of this disease and analyze our results.
MATERIAL AND METHODS: From 2005 to 2007, we have operated to 61 patients and 74 intra-abdominal testes by laparoscopy. The techniques used were the LOIS and the Fowler Stephens orquidopexy with a first stage laparoscopic and a second one inguinal. Differents features have been taken into account retrospectively.
RESULTS: Of the 74 testes operated, 16 (21.6%) were located less than 1 cm from IR (group I), 43 (58.2%) between 1 and 2 cm from IR (Group II) and 15 (20, 2%) more than 2 cm from IR. Group I: In all cases were treated with LOIS procedure. We obtained good results in 13 testes (81.2%). Two testes (12.6%) grew less than the other side and one testicle (6.2%) rose to the inguinal canal and it needed new orchiopexy. Group II: In 31 cases (72.1%) was performed a 2SFSO and in 12 (27.9%) a LOIS. Of the 31 testes intervened by 2SFSO in 22 (71.5%) was obtained good results, 6 cases (19.5%) atrophied, 2 tests (6%) grew less than the other side and one testicle rose to upper scrotum (3%) Of the 12 testes in whom the LOIS were performed in 6 (50%) achieved good results, three rose to upper scrotum (25%), one testicle (8.3%) rose to inguinal canal (8.3%) and two cases grew less than the other side (16.7%). Group III: In the 15 tests were treated with 2SFSO procedure. 10 testicles (66%) had a good result. 3 (20%) decreased in size and 2 (14%) orchiectomy was performed by severe atrophy.
CONCLUSIONS: The LOIS offers good results for testis located near to the IR. The most frequent complication of this technique is the ascend of the testes and the most one in the 2SFSO is the testicle atrophy. The surgeon's experience will play an important role in the final decision on the technique ideal in the intra-abdominal testis situated on the border between the two procedures.

Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica [Cir Pediatr]