Comparison of Two Types of Staged Laparoscopic Orchiopexy for High Intra-Abdominal Testes in Children: A Retrospective Study From a Single Center

Abstract

Background: To evaluate the efficacy and safety of 2nd-stage laparoscopic traction orchiopexy (Shehata technique) compared to Fowler-Stephens (F-S technique) for high intra-abdominal testes (IATs) in children.Patients and Methods: We performed a retrospective review of all children (<14 years old) who underwent laparoscopic treatment of high IAT in the pediatric surgery center of Yijishan Hospital of Wannan Medical College from April 2016 to April 2020. Participants were divided into the Fowler-Stephens (F-S) group and Shehata group according to the surgical method. We collected the medical records of all children and analyzed them statistically.Results: In this study, 43 patients in our center received 2nd-stage laparoscopic surgical treatment. The results showed that there were 23 high IATs in 22 patients in the F-S group and 22 IATs in 21 patients in the Shehata group. All patients completed the operation successfully. No significant difference in operation time was noted between the two groups. There was no significant difference in the testicular atrophy rate between the two groups (P = 0.323). The testicular retraction rate of the F-S group was greater than that of the Shehata group (P = 0.04).Conclusion:The results of this study indicate that the application of assisted laparoscopic testicular traction technology can effectively retain the main blood supply of the testis and vas deferens with a high survival rate and clear advantages. The preliminary results show that the Shehata technique is safe, reliable and effective in the treatment of high IAT in children.

The Management of Intraabdominal Testis: A Survey of the World Federation of Associations of Pediatric Surgeons (WOFAPS) Practices

“…In addition, Kollin et al ( 20 ) showed an improvement of testicular growth with early orchidopexy (9 months) when compared to orchidopexy at the age of 3 years. Another factor is that the distance required to lower the testicles in older boys becomes too long, which increases the risk and difficulty of surgery ( 21 ).…”

Clinical Efficacy of Laparoscopic Orchiopexy With the Modified Prentiss Maneuver for Non-palpable Testis Near the Internal Ring

“…NPT accounts for 20–35% of UDT, and NPT patients often have short spermatic cord, which have been a challenge for surgeons ( 15 – 17 ). After the exclusion of non-viable testes, NPT can be classified into intra-abdominal and intracanalicular testes according to the location of the testis ( 4 , 15 ). Various surgical strategies are currently available to address this problem.…”

“…In the treatment of high UDT, the modified Prentiss maneuver has a good clinical effect relative to the descending testis through the internal ring. However, there is still controversy over when to use primary laparoscopic orchiopexy ( 4 ). It has been reported that when the testis can reach the contralateral internal ring, primary laparoscopic orchiopexy can be used ( 3 , 5 , 6 , 16 ).…”

Open controversies on the treatment of undescended testis: An update

“…However, testicles more than 4 cm away from the inner ring are not suitable for this technique. Our team first reported a comparative study of the FSLO and Shehata techniques in the treatment of high IAT in 2021 ( 4 ). The results show that the Shehata technique can effectively retain the main blood supply of the testis and vas deferens, with a high testicular survival rate and obvious advantages.…”

“…Cryptorchidism is a common congenital malformation in pediatric urology which is also known as undescended testis (UDT) or incomplete testicular descent (1)(2)(3). According to the location of the testis, cryptorchidism can be divided into palpable testis and non-palpable testis (NPT), and palpable testis accounts for more than 80% of cryptorchidism cases (4). Cryptorchidism is associated with testicular tumors and hernia, and thus, it requires active treatment (5).…”