Recurrent torsion after previous testicular fixation

Abstract

The higher incidence of recurrent torsion after fixation using absorbable rather than non-absorbable sutures in the literature may be caused by a greater number of fixations being carried out using absorbable suture. Use of non-absorbable suture is limited by the high rate of abscess formation. The most important factor for adhesion formation would appear to be the eversion of the tunica vaginalis and it is recommended that this is carried out at all testicular fixations.

Testicular torsion: a 15‐year single‐centre clinical and histological analysis

“…However, the use of nonabsorbable suture is limited because it is associated with a high rate of abscess formation. Hence, it has been suggested that the most important factor for adhesion formation would appear to be the eversion of the tunica vaginalis, and it is recommended that this is carried out at all testicular fixations (23).…”

Re‐presentations and recurrent events following initial management of the acute paediatric scrotum: a 5‐year review

“…11 A subsequent study by Mor et al identified a recurrence rate of 4%, occurring 6 months to 23 years following orchiopexy. 11 A subsequent study by Mor et al identified a recurrence rate of 4%, occurring 6 months to 23 years following orchiopexy.…”

“…Mushtaq et al described a return rate of 4% in those undergoing exploration, 38% of whom were metachronous, compared with 10% and 25% in our cohort, respectively. 7,8,11 Four and a half percent of boys in our centre re-presented following surgery with pain, swelling or redness deemed within normal post-operative limits, and were subsequently discharged with no intervention. 7 They described a re-exploration rate of 7.6% (64/840) over a 11-year period, with three of these boys each requiring three acute scrotal explorations.…”

“…Testicular torsion recurrence following orchiopexy has been previously reported to be relatively rare, with a review by Sells et al identifying only 20 cases on review of the available literature. 11 A subsequent study by Mor et al identified a recurrence rate of 4%, occurring 6 months to 23 years following orchiopexy. 8 We report a recurrence rate of 0.3% (1/292) of testicular torsion following orchiopexy, potentially supporting the performance of routine orchiopexy on scrotal exploration, not only to reduce the risk of subsequent testicular torsion but also to minimize the frequency of re-presentations to hospital; however, a longer follow-up period would be required to validate such data.…”

“…The time elapsed between initial presentation and subsequent return to hospital has previously been reported to vary from 1 day to 23 years. 7,8,11 Four and a half percent of boys in our centre re-presented following surgery with pain, swelling or redness deemed within normal post-operative limits, and were subsequently discharged with no intervention. Waldert et al described a similar re-presentation rate, with 6.7% of boys returning with inflammation/oedema with no intervention required.…”