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Simultaneous laparoscopic orchiopexy and high ligation for concurrent inguinal hernia and nonpalpable undescended
Sung Ryul Lee1, Rae Yoon Jeong2
1Department of Surgery, Damsoyu Hospital, 234 Hakdong-ro, Gangnam-gu, Seoul, Republic of Korea. kingsoss@naver.com.
Insights
Simultaneous laparoscopic surgery for inguinal hernia and nonpalpable undescended testis in infants aged 4-12 weeks is safe and feasible. This approach avoids delaying orchiopexy and shows no increase in complications or recurrence.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Neonatal Urology
Background:
- Inguinal hernia (IH) and undescended testis (UDT) frequently coexist in infants.
- Optimal surgical timing for concurrent IH and UDT, especially nonpalpable UDT, remains debated.
- Spontaneous testicular descent is unlikely after 6 months of age.
Purpose of the Study:
- To evaluate the feasibility and safety of simultaneous laparoscopic orchiopexy with high ligation in infants aged 4-12 weeks with concurrent IH and nonpalpable UDT.
- To assess operative outcomes and postoperative complications of this combined approach.
Main Methods:
- Retrospective review of infants aged 4-12 weeks undergoing laparoscopic IH repair.
- Simultaneous laparoscopic orchiopexy with high ligation performed for concurrent nonpalpable UDT.
- Analysis of operative outcomes and postoperative complications.
Main Results:
- 60 out of 2,329 infants (2.6%) had concurrent nonpalpable UDT.
- Simultaneous orchiopexy was successful in 59 infants; one required orchiectomy due to ischemia.
- The IH + UDT group had longer operative times but no significant differences in postoperative complications, hospital stay, or recurrence.
- No testicular atrophy or reoperation was noted during follow-up.
Conclusions:
- Simultaneous laparoscopic orchiopexy with high ligation is a safe and feasible surgical option for selected infants.
- This approach addresses both inguinal hernia and nonpalpable undescended testis concurrently in early infancy.
- Early intervention with this combined technique shows favorable outcomes without increased risks.
Purpose:
Inguinal hernia (IH) and undescended testis (UDT) frequently coexist in infants, creating a dilemma regarding optimal surgical timing. Although early IH repair is recommended to prevent incarceration, orchiopexy is typically deferred to allow for potential spontaneous testicular descent. However, spontaneous descent occurs predominantly within the first few months of life and is unlikely after 6 months, particularly in cases of nonpalpable UDT. Despite these considerations, evidence guiding the management of infants with concurrent IH and nonpalpable UDT, especially during early infancy, remains limited. Therefore, this study aimed to evaluate the feasibility, safety, and outcomes of simultaneous laparoscopic orchiopexy with high ligation in infants aged 4-12 weeks with concurrent IH and nonpalpable UDT.
Methods:
We retrospectively reviewed infants aged 4-12 weeks who underwent laparoscopic IH repair between January 2013 and December 2024. Infants with concurrent nonpalpable UDT underwent simultaneous laparoscopic orchiopexy with high ligation. Operative outcomes and postoperative complications were analyzed.
Results:
Among 2,329 infants, 60 (2.6%) had concurrent nonpalpable UDT. Simultaneous orchiopexy was performed in 59 infants, whereas one infant underwent orchiectomy due to testicular ischemia secondary to spermatic cord strangulation. Although operative time was longer in the IH + UDT group, no significant differences were observed in postoperative complications, length of hospital stay, or recurrence. No testicular atrophy or reoperation was observed during the follow-up.
Conclusion:
Simultaneous laparoscopic orchiopexy with high ligation appears to be a safe and feasible approach in selected infants aged 4-12 weeks with concurrent IH and nonpalpable UDT.
