A prospective comparative study of open versus laparoscopic stage II Fowler-Stephens orchidopexy in pediatric...

Laparoscopic Fowler Stephens orchidopexy, single stage or two-stage, is now routinely performed in non-palpable testis. We performed second stage orchidopexy as open inguinal approach and compared the outcome of this approach to two-staged laparoscopic orchidopexy.

We performed a prospective randomized interventional study of two different approaches for intra-abdominal testis. In group A, Laparoscopic stage I (SFO) followed by open inguinal orchidopexy was compared for final outcome in group B cases, who underwent laparoscopic staged SF orchidopexy. The average duration between stage I SF and stage II SF was 6 months. All the procedures were done under GA and caudal analgesia. The pre-operative and post-operative USG dimensions were compared in cm and cm³/ml. The procedure outcome was considered successful if testis remained inside scrotum below mid-scrotal point. Any testis above the mid-scrotal point was considered as unacceptable or failure of procedure.

This study was performed on 74 children with 84 testis (group 'A' 38 patients (48 testis) and group 'B' 36 patients (46 testes)), with average age was 3.3 ± 0.46 and 3.9 ± 0.58 years, respectively. In group 'A', 38 patients (48 testes) underwent lap SFO I followed by inguinal orchidopexy and in group 'B', 36 patients (46 testes) underwent laparoscopic staged SF O. The mean testicular volume pre-operative in group 'A' & 'B' was 0.28 ± 0.04 and 0.23 ± 0.06 cm², respectively. The mean post-operative testicular volume was 0.34 ± 0.07 and 0.28 ± 0.05 cm², respectively. The average follow-up of the patients in group 'A' & 'B' was 24 ± 3.67 and 20 ± 2.90 months, respectively. Testis was having good volume in 87.5% and 76.60% of these successful cases, respectively. There were (3/48) 6.25% (4/46) 8.69% testicular atrophy cases in group 'A' & 'B', respectively. The differences were not statistically significant (p < 0.05). The mean operative time in group A was 20 ± 8.07 min and group B 30 ± 7.19 min in stage II procedure.

The success rate in group A was more than the group B which was statistically significant (p > 0.05). Our study connotes that open stage II orchidopexy is still feasible and practicable with better final outcome of management of non-palpable cases.