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Published on: September 13, 2022
Is it necessary to close the peritoneum over the deep inguinal ring during laparoscopic orchidopexy?
Ahmed Khairi1, Sameh Shehata, Nour El-Kholi
1Pediatric Surgery Unit, Alexandria Faculty of Medicine, Alexandria, Egypt. ahmedkhairi@hotmail.com
Background:
During laparoscopic orchidopexy, some authors routinely close the peritoneum over the area of the deep inguinal ring (DIR). We report our experience, to determine whether leaving the peritoneum over the DIR without closure is associated with an increase in the occurrence of postoperative inguinal hernia.
Patients & Methods:
This is a retrospective review of patients who underwent laparoscopy for impalpable testes in 2004-2010. The patients were divided into two groups: I) cases in whom the peritoneum over the DIR was routinely closed, and II) cases in whom the DIR was left without closure. The patients were followed up in the outpatient clinic.
Results:
During the study period, 442 boys underwent laparoscopy for 570 impalpable testes. The testis was found to be 'vanishing' or 'atrophic' in 182 (32%). The mobilized testis passed through the anatomical DIR in 198 (51%), and through a new deep ring in 190 (49%). The DIR was closed (I) in 178 (46%) and left open (II) in 210 (54%) cases. On follow up (mean 50 months for I and 41 months for II), there were no cases of inguinal hernia.
Conclusion:
Closing the peritoneum over the area of the DIR may not be necessary, even in cases where the testis has to be passed through a medially created new deep ring, because of a short cord.