Journal of pediatric surgery · 2025
Outcomes of laparoscopic orchiopexy for intra-abdominal testis: A single institutional experience.
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Sacco Casamassima Maria G, Saylors Seth, Noel-Macdonnell Janelle R, Dizdarevic Emina, Zaidi Rohma, Gatti John, Koenig Joel F, Meier Kristen, St Peter Shawn D
Аннотация
BACKGROUND: The optimal surgical technique for intrabdominal undescended testes (IAT) with short spermatic vessels remains controversial. This study aims to review our experience in managing IAT and explore patient and surgical predictors of outcomes.
METHODS: A single-institution retrospective study of children ≤10 years old who underwent laparoscopic orchiopexy for IAT was conducted(January 2013-December 2023). Direct orchiopexy without spermatic vessels division (DO) was used as a baseline comparison for either single-stage (SSO) or two-stage (2SO) orchiopexy with vessel division. The primary outcome of interest was atrophy rate. Secondary outcomes were the final testicles' position and reoperation. Differences between groups were compared using Fisher's exact and Mann-Whitney U tests. Multivariable logistic regression analysis was performed to identify predictors of testicular loss following orchiopexy.
RESULTS: During the study period, 298 orchiopexies for IAT were performed: 112 were DO (37.6 %), 98 SSO (32.9 %), and 88 (29.5 %) 2SO, respectively. Outcomes were available for 260 (87.3 %) testicles. Testicular atrophy was observed in 6.2 % of DO, 19.3 % of SSO, and 10.7 % of 2SO. (p = 0.019). However, differences between SSO and 2SO were not statistically significant (p = 0.132). Multivariable analysis found no significant predictors of atrophy. Two testicles required redo orchiopexy in the 2SO group, and a suspected inguinal hernia required laparoscopic exploration in the DO group.
CONCLUSIONS: When spermatic vessels are too short to perform an orchiopexy without their division, the single-stage approach is associated with a potentially higher rate of testicular atrophy. However, when the gubernaculum is preserved, there are no differences between single-stage and two-stage orchiopexy.
METHODS: A single-institution retrospective study of children ≤10 years old who underwent laparoscopic orchiopexy for IAT was conducted(January 2013-December 2023). Direct orchiopexy without spermatic vessels division (DO) was used as a baseline comparison for either single-stage (SSO) or two-stage (2SO) orchiopexy with vessel division. The primary outcome of interest was atrophy rate. Secondary outcomes were the final testicles' position and reoperation. Differences between groups were compared using Fisher's exact and Mann-Whitney U tests. Multivariable logistic regression analysis was performed to identify predictors of testicular loss following orchiopexy.
RESULTS: During the study period, 298 orchiopexies for IAT were performed: 112 were DO (37.6 %), 98 SSO (32.9 %), and 88 (29.5 %) 2SO, respectively. Outcomes were available for 260 (87.3 %) testicles. Testicular atrophy was observed in 6.2 % of DO, 19.3 % of SSO, and 10.7 % of 2SO. (p = 0.019). However, differences between SSO and 2SO were not statistically significant (p = 0.132). Multivariable analysis found no significant predictors of atrophy. Two testicles required redo orchiopexy in the 2SO group, and a suspected inguinal hernia required laparoscopic exploration in the DO group.
CONCLUSIONS: When spermatic vessels are too short to perform an orchiopexy without their division, the single-stage approach is associated with a potentially higher rate of testicular atrophy. However, when the gubernaculum is preserved, there are no differences between single-stage and two-stage orchiopexy.