Inguinal cordopexy: A simple and effective new technique for securing the testes in reoperative orchiopexy

Laparoscopy-assisted orchiopexy for recurrent undescended testes in children

“…In the en block mobilization technique described by Cartwright et al [4], a strip of the external oblique aponeurosis remains attached to the spermatic cord. Fixing this strip to the pubic bone or to the tendinous part of the muscles of area avoids subsequent tension to the distal part of cord, allowing the testis to remain in the scrotum without tension [6]. In our series, after inguinal dissection and laparoscopic mobilization of testicular vessels, most of the spermatic cord was free of tension.…”

“…Inguinal mobilization of testicular vessels together with extensive retroperitoneal dissection cannot deliver the testis in satisfactory position in some of these cases [5]. Difficulty in mobilization, as well as significant complications including atrophy, have led to a multitude of approaches to this dilemma [5,6].…”

The Transscrotal Approach for Recurrent and Iatrogenic Undescended Testes

“…An inability to place the testis into the scrotum during indirect inguinal hernia or hydrocele surgery and scar tissue that develops later may pull the testis up and lead to iatrogenic undescended testis [8] . It is interesting that success rates of 96 -100 % have been reported for redo orchiopexy for testes that were placed into the scrotum during the previous surgery [3,9,10] . These results indicate that the failure of the fi rst surgery is due more to an inadequate surgical technique than to problems with the spermatic cord itself.…”

“…Cartwright et al described en bloc spermatic cord mobilization, where the old inguinal section is used to start dissection from the lower testicular pole and en bloc mobilization is performed by leaving the external oblique aponeurosis adherent to the spermatic cord on the cord like a strip without dissecting the spermatic cord and using external oblique aponeurosis where the scar tissue is most dense [3] . Palacio et al described an inguinal cordopexy method where the spermatic cord is mobilized in a way similar to the one above and the external oblique aponeurosis strip, which is strongly adherent to the spermatic cord, is then fi xed to the pubic bone or the tendinous section of the gracilis muscle with nonabsorbable sutures [9] . Redman has defi ned a technique where the external oblique aponeurosis is opened laterally and the vas deferens and spermatic vessels are dissected from the surrounding fascia and muscles while working in a fi eld with no scar tissue [11] .…”

Our Surgical Experiences in Recurrence Undescended Testis

“…Çünkü amaç tüm yetenek, beceri ve bakım tekniklerini kullanarak tes-tisi korumak ve testiküler fonksiyonların zarar görmesini engellemektir. Hidrosel ve inguinal herni onarımı sonrası inmemiş testis en yüksek %2 görülürken bu oran inguinal orşiopeksi sonrası %10-13 olarak bildirilmiştir (1)(2)(3)(4)(5). Sekonder ve tersiyer inmemiş testis onarımlarında inguinal, skrotal, laparoskopik, preperitoneal olmak üzere yazarlar çeşitli metodlarını tarif etmişler ve kendi tekniklerinin testis ve vaz deferensi korumak için en güvenilir teknik old-uğunu savunmuşlardır (1-9).…”