Undescended Testes and Laparoscopy: Experience from the Developing World

ELE GELMEYEN TESTİSTE LAPAROSKOPİ DENEYİMİMİZ

AIM: To demonstrate the superiority of laparoscopic undescended testicular surgery for nonpalpable testicles in children in diagnosis and treatment. METHODS: The files of patients between the age of 6 months-18 years who underwent laparoscopic undescended testis investigation due to nonpalpable testis in our clinic between January 2010 and September 2021 were reviewed retrospectively. Patients with palpable testicles and patients with disorders of sex development in the examination performed under general anesthesia were excluded from the study. RESULTS: 53 patients were included in the study. The mean age of the patients is 3.2 years (min: 8 months-max 17 years). Laparoscopic intervention was performed for a total of 59 nonpalpable testicles which were left-sided in 54.7% (n=29) of the patients, right-sided in 34% (n=18), and bilateral in 11.3% (n=6). Throughout these 59 testicles, cords and vessels of 31 testicles were visualized entering the inguinal canal, atrophic testes in the abdomen were detected in 7 patients, the cord and vessels had an intraabdominal blind ending (vanishing testis) in 7 patients, and 14 testicles were in the abdomen with normal aspect. CONCLUSION: Simultaneous laparoscopic orchiectomy is performed in case of atrophic testis in laparoscopic exploration for nonpalpable testicles. It allows the ligation of vessels of testes farther than 2 cm away from the inguinal canal, and for testes that are closer than 2 cm it grants the vessels to be released under a more precise vision thereby protecting from the complications of conventional surgery.

Comparison of Laparoscopic Orchiopexy and Traditional Inguinal Incision Orchiopexy for Palpable Undescended Testes in Cryptorchidism

Background: Laparoscopic orchiopexy (LO) has become a standard procedure for the treatment of nonpalpable undescended testes (UDT). LO for palpable UDT is still controversial. The aim of this study is to explore the method and effect of LO procedure for palpable UDT in children suffering from cryptorchidism. Methods: A retrospective study was performed for LO and traditional inguinal incision orchiopexy (TIO) for palpable UDT. A total of 291 children were enrolled, and they were aged 9-96 months with either left- or right-side palpable inguinal canalicular testes. Patients with testes that were nonpalpable, ectopic, and retractable were excluded. One hundred seventy patients received LO and 121 patients received TIO. Patient age, operative time, and clinical outcomes were reviewed. Independent t-test and Fisher's exact test were performed by SPSS 25.0 software. Results: The mean operative time (30.77 ± 6.02 minutes versus 44.76 ± 6.70 minutes) and postoperative normal activity time (1.25 ± 0.43 days versus 2.48 ± 0.68 days) of LO were significantly shorter than those of TIO group (P < .05). Forty-seven of 49 cases (95.9%) aged <1 year successfully achieved LO. Conclusion: LO is an appropriate choice for palpable UDT, especially in younger children aged <2 years. The success rate of LO decreased with age.

Anaesthesia concerns and perioperative management in a child with DiGeorge syndrome with corrected tetralogy of Fallot with pulmonary atresia posted for laparoscopic orchidopexy: Case report

DiGeorge syndrome is afflicted with multiple congenital anomalies such as conotruncal and craniofacial anomaly, immune system dysfunction and hypoplasia/aplasia of parathyroid glands. Laparoscopy is a preferred surgical approach over open orchidopexy due to better visualisation of impalpable testis avoiding long incision, minimal tissue damage and a faster recovery. We report a case of DiGeorge syndrome with corrected tetralogy of Fallot with pulmonary atresia in a 1-year-old male child posted for laparoscopic orchidopexy. The anaesthesiologists face unique challenges due to the multisystem involvement and the effects of laparoscopic surgery on multiple organs. Thorough understanding of DiGeorge syndrome is essential for a good perioperative outcome.