For Better Orchiopexy, Processus Vaginalis Should Be Dissected and a High Ligation Should Be Performed

Sönmez, Kaan; Karabulut, Ramazan; Türkyılmaz, Zafer; Kaya, Cevdet; Pehlivan, Yildiz; Başaklar, A. Can

doi:10.5041/rmmj.10247

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…However when the testis is in a higher position, such as in the inguinal canal or just at the external ring, TSO brings troublesome complications include injury to the vas deferens and testicular vessels. In 2016, Lopes et al published articles about post-operation complications ( 15 , 16 ). Hernia, hydrocele, testicle ascending and atrophy happens, owing to insufficient (retroperitoneal) mobilization of vas and vessels and/or inadequate high ligation of patent processus vaginalis.…”

Section: Discussionmentioning

confidence: 99%

Single-Port Laparoscopic Assisted Transcrotal Orchidopexy for Palpable Inguinal Canalicular Cryptorchidism Accompany With Indirect Inguinal Hernia

Cai

et al. 2018

Front. Pediatr.

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Purpose: To assess the outcomes of a novel laparoscopic assisted transcrotal orchidopexy (LATO) combined with percutaneous extraperitoneal closure (PEC) for palpable inguinal canalicular cryptorchidism accompany with indirect inguinal hernia, and evaluate its safety and efficiency.Materials and Methods: A retrospective cohort study for single-port LATO-PEC and traditional inguinal orchidopexy (TIO) was performed between 2011 and 2014. Totally 53 children with both palpable inguinal canalicular testes and indirect inguinal hernia were included. Median patient age was 15month (range, 6 months to 4 years). Of them, 35 patients underwent LATO-PEC procedure, utilizing an umbilical trocar for laparoscope, transcrotal dissection for orchidopexy, and an inner two-hooked cannula for ligation of the patent processus at the level of the internal ring. Three of them were bilateral, 12 on the left side and 20 on the right. Eighteen patients received TIO, seven of them on the left side and 11 on the right. Patient demographics, surgical technique, complications, and clinical outcomes were reviewed. Follow-up visits were performed to reassess position and size of the testes.Results: All 56 undescended testes were delivered into the scrotum successfully. In the LATO-PEC group, nine contralateral herniorrhaphy were accomplished simultaneously. Fifteen contralateral patent processus vaginalis (PPVs) in 32 unilateral undescended testis (UDT) were newly confirmed during the laparoscopy, while 6 of them received percutaneous extra-peritoneal herniorrhaphy for visible inguinal bubble in pneumoperitoneum condition. No additional port placement or conversion to open procedure was needed. Mean operative time for unilateral and bilateral LATO-PEC in this study was (37.81 ± 5.23) min and (53.33 ± 2.98) min, respectively. In TIO group, mean operative time was (41.11 ± 8.67) min. There was no statistical difference in operative time between the two approaches for unilateral UDTs (p = 0.098). Median follow-up interval was 24 months (range, 12–84 months). No operative complications were found in either group to date.Conclusions: Singe-port LATO-PEC is a safe, effective, and cosmetic choice for inguinal canalicular cryptorchidism accompany with indirect inguinal hernia, minimizing injuries to the vas deferens and testicular vessels. Laparoscopy can provide a diagnostic and therapeutic solution of contralateral PPV.

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Section: Discussionmentioning

confidence: 99%

Single-Port Laparoscopic Assisted Transcrotal Orchidopexy for Palpable Inguinal Canalicular Cryptorchidism Accompany With Indirect Inguinal Hernia

Cai

et al. 2018

Front. Pediatr.

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“…However, the controversy over the management of PPV during surgical exploration persists. 21 , 22 It remains for the surgeon to decide whether it is worthwhile to prevent a metachronous hernia with a probability of approximately 6%. 23 Finally, low birth weight and preterm birth, which were closely associated with cryptorchidism and PPV, were not analyzed in this study because the number of patients with low birth weight or preterm birth was too small to be statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Ipsilateral and contralateral patent processus vaginalis in pediatric patients with a unilateral nonpalpable testis

Xie

Huang

et al. 2023

Asian Journal of Andrology

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This study aimed to investigate the incidence of patent processus vaginalis (PPV) in pediatric patients with a unilateral nonpalpable testis and explore the associated factors. From May 2014 to April 2017, 152 boys who were diagnosed with a unilateral nonpalpable testis and underwent laparoscopy in Shanghai Children’s Hospital (Shanghai, China) were included in this study. The data were collected and reviewed, and the results were analyzed regarding the age at operation, side, development, and position of the nonpalpable testis. The mean age of the patients was 2.6 (standard deviation: 2.3) years. The testis was absent in 14 cases, nonviable in 81 cases, and viable in 57 cases. The incidence of PPV was 37.5% (57 of 152) on the ipsilateral side and 16.4% (25 of 152) on the contralateral side. The ipsilateral PPV was more prevalent when the nonpalpable testis occurred on the right side (P < 0.01). Besides, patients with a viable testis had a greater incidence of ipsilateral PPV than those with a nonviable or absent testis (P < 0.01). Moreover, this rate was the highest when the testis was in the abdominal cavity and the lowest when the testis was in the scrotum (both P < 0.01). However, the incidence of contralateral PPV was independent of all the factors. In conclusion, in children with a nonpalpable testis, the incidence of an ipsilateral PPV was significantly related to the side, development, and position of the testis, while it was independent of these factors on the contralateral side.

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“…Indirect inguinal hernia is common in the pediatric age group. It is often congenital and arises from a patent processus vaginalis, a peritoneal channel that has failed to close and is also found in up to 90% of undescended testes (1)(2)(3). Although some surgeons suggested the nonligation of the processus vaginalis in the context of a indirect hernia and orchidopexy, their findings were based on limited evidence to be interpreted with suspicion (4,5).…”

Section: Discussionmentioning

confidence: 99%

“…High ligation was considered as essential to avoid recurrence of indirect inguinal hernia and is also the standard part of inguinal orchiopexy for patent processus vaginalis (1,(6)(7)(8). Sonmez et al demonstrated the importance of dissection and high ligation of processus vaginalis to prevent hernia formation and provide a tension-free orchidopexy procedure (2).…”

Section: Discussionmentioning

confidence: 99%

Dev İnguinal Herni Onarımı veya Orşiopeksi Sırasında Yırtılan Fıtık Kesesi İçin Basit ve Etkili Bir Teknik: İnsizyon

KARAKUŞ,

SUZEN,

ERTURK

2023

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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Tearing of hernial sac during giant inguinal hernia repair or orchiopexy presents a challenge to the pediatric surgeons, even in expert hands. We here describe a technique that is easy for performing high ligation in cases complicated with torn hernial sac. The steps of our incision technique is: Non-separated part was tightened with the help of forceps localized at the lateral aspects of teared sac. The incision to the sac was fashioned by scalpel No 15, while taking care to avoid injury to the underlying testicular vessels and vas deferens. Then, wound edges of the proximal hernia sac were moved forward by using fine tissue forceps and scalpel. The walls of proximal sac were totally grasped in one forceps and dissected gently from the remaining adhesions and cremasteric fibers up to the level of the internal ring. The mean age of the patients was 13.9±18.1 months (range 3 weeks-7 years). The diagnosis of the patients was inguinal hernia in 17 (63%) and undescended testis in 10 (37%). Seven (25,9%) of the patients had a large inguinal hernia sac. There were no intraoperative and postoperative complications. This is a safe and effective technique in patients complicated with torn hernial sac during herniotomy. It reduces the risk of further tearing of hernial sac. Short duration is another advantage. This technique can also be performed with using surgical loupe or microscope to care not to damage the vas and vessels.

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For Better Orchiopexy, Processus Vaginalis Should Be Dissected and a High Ligation Should Be Performed

Cited by 6 publications

References 12 publications

Single-Port Laparoscopic Assisted Transcrotal Orchidopexy for Palpable Inguinal Canalicular Cryptorchidism Accompany With Indirect Inguinal Hernia

Single-Port Laparoscopic Assisted Transcrotal Orchidopexy for Palpable Inguinal Canalicular Cryptorchidism Accompany With Indirect Inguinal Hernia

Ipsilateral and contralateral patent processus vaginalis in pediatric patients with a unilateral nonpalpable testis

Dev İnguinal Herni Onarımı veya Orşiopeksi Sırasında Yırtılan Fıtık Kesesi İçin Basit ve Etkili Bir Teknik: İnsizyon

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