[Laparoscopic orchiopexy for inguinal palpable cryptorchidism].

OBJECTIVE

To investigate the feasibility and advantages of laparoscopic orchiopexy in the treatment of inguinal palpable cryptorchidism.

METHODS

This study included 773 cases of inguinal palpable cryptorchidism with 869 undescended testes, 218 on the left, 459 on the right and 96 bilaterally. The patients were aged 6 months to 8 years, averaging 20 months. The surgical procedures involved cutting open the posterior peritoneal wall with the ultrasonic scalpel, dissecting the spermatic cord close to the inferior pole of the kidney, separating the posterior peritoneum from the vas deferens, severing the testicular gubernaculum, pulling the testis back into the abdominal cavity and, with the vas deferens protected, bringing the testis down into the scrotum and getting it fixed.

RESULTS

All the operations were successfully performed, with an average operation time of 34.8 ± 5.4 minutes and no conversion to open surgery. Ipsilateral patent processus vaginalis was found in 692 (89.5%) of the 773 cases, and contralateral concealed hernia in 233 (34.4%) of the 677 cases of unilateral cryptorchidism, which were all treated by high ligation of the hernial sac. There was no subcutaneous emphysema intraoperatively or vomiting, abdominal distension, wound bleeding and obvious pain postoperatively. The patients were followed up for 6 to 18 months, during which, regular Doppler ultrasonography revealed that the testes were located in the scrotum with no testicular retraction and atrophy, inguinal hernia or hydrocele.

CONCLUSIONS

Laparoscopic orchiopexy is safe and effective for the treatment of inguinal palpable cryptorchidism, and meanwhile can be used for the detection and management of contralateral concealed hernia and the prevention of metachronous inguinal hernia.