Simultaneous laparoscopic orchiopexy and high ligation for concurrent inguinal hernia and nonpalpable undescended testis in young infants.

PURPOSE: Inguinal hernia (IH) and undescended testis (UDT) frequently coexist in infants, creating a dilemma regarding optimal surgical timing. Although early IH repair is recommended to prevent incarceration, orchiopexy is typically deferred to allow for potential spontaneous testicular descent. However, spontaneous descent occurs predominantly within the first few months of life and is unlikely after 6 months, particularly in cases of nonpalpable UDT. Despite these considerations, evidence guiding the management of infants with concurrent IH and nonpalpable UDT, especially during early infancy, remains limited. Therefore, this study aimed to evaluate the feasibility, safety, and outcomes of simultaneous laparoscopic orchiopexy with high ligation in infants aged 4-12 weeks with concurrent IH and nonpalpable UDT.

METHODS: We retrospectively reviewed infants aged 4-12 weeks who underwent laparoscopic IH repair between January 2013 and December 2024. Infants with concurrent nonpalpable UDT underwent simultaneous laparoscopic orchiopexy with high ligation. Operative outcomes and postoperative complications were analyzed.

RESULTS: Among 2,329 infants, 60 (2.6%) had concurrent nonpalpable UDT. Simultaneous orchiopexy was performed in 59 infants, whereas one infant underwent orchiectomy due to testicular ischemia secondary to spermatic cord strangulation. Although operative time was longer in the IH + UDT group, no significant differences were observed in postoperative complications, length of hospital stay, or recurrence. No testicular atrophy or reoperation was observed during the follow-up.

CONCLUSION: Simultaneous laparoscopic orchiopexy with high ligation appears to be a safe and feasible approach in selected infants aged 4-12 weeks with concurrent IH and nonpalpable UDT.