The difficult orchidopexy: the value of the abdominal pre-peritoneal approach

To analyse the outcome of using the abdominal pre-peritoneal (APP) approach to orchidopexy.

During an 8-year period, the experience of one surgeon in the management of 553 boys (median age 4.5 years, range 1-13) with undescended testes (596 testes) was assessed. The analysis emphasized those patients who had an orchidopexy performed using the APP approach detailing; the original position of the testis at exploration, whether successful placement within the scrotum was possible, and whether atrophy or ascent of the gonad occurred subsequently.

In 98 boys (110 testes) the testes were impalpable or high within the inguinal canal and they were explored using the APP approach. Of the 34 testes (31%) which were found abdominally, 12 were high intra-abdominal and the remaining 22 just deep to the internal inguinal ring. These included seven bilateral and 20 unilateral intra-abdominal testes. The remaining 76 undescended testes included five with bilateral high testes, 29 high unilateral testes, 13 repeat orchidopexies, 17 'vanishing testis syndrome' and seven atrophic testes. The remaining 486 undescended testes were treated using a standard orchidopexy and were therefore excluded from analysis.

The value and advantages of this operative approach and its place in the management strategy of the difficult orchidopexy are discussed.