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Risk factors influencing ascending testis after laparoscopic percutaneous extraperitoneal closure for pediatric
Juma Obayashi1, Munechika Wakisaka1, Kunihide Tanaka1
1Department of Pediatric Surgery, St. Marianna University Yokohama-City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Japan.
Insights
Low birth weight and specific surgical techniques during laparoscopic percutaneous extraperitoneal closure (LPEC) increase the risk of ascending testis. Avoiding the spermatic duct and preventing hematoma are key factors in reducing this complication.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Ascending testis is a potential complication following laparoscopic percutaneous extraperitoneal closure (LPEC).
- Identifying risk factors is crucial for preventing this adverse outcome in pediatric patients undergoing hernia or hydrocele repair.
Purpose of the Study:
- To investigate the risk factors associated with ascending testis after LPEC.
- To identify specific operative findings and patient characteristics that predict this complication.
Main Methods:
- Retrospective review of medical records and operative videos for boys undergoing LPEC between 2014 and 2018.
- Comparison of baseline characteristics and operative details between patients who developed ascending testis (Group A) and those who did not (Group B).
- Evaluation of needle path (Not Crossing spermatic duct), needle entry site (Different Hole), peritoneal injury (Re-ligation), and hematoma formation.
Main Results:
- Lower birth weight was significantly associated with ascending testis (p=0.035).
- The LPEC needle not crossing the spermatic duct on the first circuit was more frequent in Group A (100% vs 41%, p=0.002).
- Hematoma formation was also a significant risk factor (29% in Group A vs 5% in Group B, p=0.047).
Conclusions:
- Birth weight below 932g is a predictor of ascending testis post-LPEC.
- Surgical factors, including the needle's path relative to the spermatic duct and the occurrence of hematoma, are critical in preventing ascending testis.
Background:
We investigated the risk factors influencing ascending testis following laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia or hydrocele.
Methods:
Boys undergoing LPEC between 2014 and 2018 had their medical records and operative movies reviewed. Group A patients required orchiopexy after LPEC. Group B patients did not. Their baseline characteristics were reviewed. The path of the LPEC needle (not crossing the spermatic duct at first circuit [Not Crossing]), whether the second entry of the LPEC needle was different from the first hole (Different Hole), peritoneal injury requiring re-ligation (Re-ligation), and hematoma (Hematoma) were evaluated. The quantitative factors of significant difference were set as a cut-off value.
Results:
There were 5 patients (7 sides) in Group A and 162 patients (237 sides) in Group B. Birth weight was lower in Group A (p = 0.035). Not Crossing was 7 sides (100%) in Group A and 97 sides (41%) in Group B (p = 0.002). Hematoma was 2 sides (29%) in Group A and 11 sides (5%) in Group B (p = 0.047). Cut-off value of birth weight was 932 g (AUC 0.78).
Conclusion:
Birth weight < 932 g and operative findings (not crossing over the spermatic duct on the first circuit and hematoma) indicated an increased risk of ascending testis after LPEC.
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