Laparoscopic staged management of high intrabdominal testis: A prospective randomized study

Area of Science:

• Pediatric Surgery
• Urology
• Minimally Invasive Surgery

Background:

• Undescended testes, specifically high intra-abdominal testis (IAT), pose management challenges in pediatric patients.
• Laparoscopic orchiopexy is a common surgical approach for IAT.
• Staged laparoscopic techniques offer alternatives for complex cases.

Purpose of the Study:

• To prospectively compare the outcomes and complications of two staged laparoscopic techniques for managing high intra-abdominal testes (IAT) in children.
• To evaluate the efficacy and safety of staged Fowler-Stephens laparoscopic orchiopexy (FSLO) versus staged laparoscopic traction orchiopexy (SLTO).

Main Methods:

• A prospective study involving 45 patients with unilateral high IAT, randomized into two groups: FSLO and SLTO.
• Data collected included operative time, intraoperative complications, success rate, final scrotal position, testicular size, and vascularity at 6-month follow-up.
• Comparison of outcomes between the two staged laparoscopic techniques.

Main Results:

• Both FSLO and SLTO achieved comparable success rates regarding final scrotal position.
• Testicular atrophy occurred in 3 cases (14.3%) in the FSLO group, versus none in the SLTO group (p=0.048).
• No intraoperative or postoperative complications were reported for either technique.

Conclusions:

• Both staged laparoscopic techniques are effective for achieving a low scrotal position in high IAT management.
• Staged laparoscopic traction orchiopexy (SLTO) offers a superior outcome by significantly reducing the risk of testicular atrophy compared to FSLO.
• SLTO is a favorable option for managing high undescended testes in children.