1
|
Tao C, Cao Y, Liu X, Mao C. Laparoscopic-Assisted Scrotal Approach for the Treatment of Inguinal Cryptorchidism with Patent Processus Vaginalis: Clinical Efficacy Analysis. J Laparoendosc Adv Surg Tech A 2024; 34:664-669. [PMID: 38010263 DOI: 10.1089/lap.2023.0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Objective: This study aimed to compare the clinical outcomes of two surgical approaches, laparoscopic-assisted scrotal incision and conventional inguinal-scrotal incision, for treating cryptorchidism with unobliterated processus vaginalis. Methods: Clinical data from 60 pediatric patients with inguinal cryptorchidism who were admitted to our institution between January 2018 and January 2022 were retrospectively analyzed. Depending on the surgical technique used, the patients were split into two groups: the laparoscopic group (n = 30) underwent a laparoscopic-assisted scrotal incision, whereas the conventional group (n = 30) underwent a conventional inguinal-scrotal incision for testicular descent and fixation. The length of the procedure, intraoperative blood loss, and the typical hospital stay following the procedure were compared between the two groups. Also assessed was the frequency of postoperative complications including wound infection and hematoma development. Results: The laparoscopic group demonstrated a notably shortened average surgical duration compared with the traditional group, and this discrepancy held statistical significance (P = .017). Moreover, the laparoscopic approach resulted in a reduced volume of intraoperative blood loss, with a statistically significant distinction (P = .002), along with a decreased average length of hospital stay after surgery, also statistically significant (P = .009). Testicular retraction, atrophy, inguinal hernias, or hydrocele were not present in any group. Although the difference between the laparoscopic and open groups was not statistically significant (P > .05), the laparoscopic group saw a reduced frequency of scrotal hematoma. The frequency of wound infection was also decreased in the laparoscopic group compared with the open group, although there was no statistically significant difference (P > .05). Conclusion: The laparoscopic-assisted scrotal incision approach for testicular descent and fixation offers precise localization of cryptorchidism, reduced surgical trauma, shorter postoperative recovery time, and results in smaller scars with minimal tissue damage. The procedure showcases enhanced overall clinical effectiveness, fewer postoperative complications, heightened safety, and superior cosmetic outcomes.
Collapse
Affiliation(s)
- Chengpin Tao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Yongsheng Cao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Xiang Liu
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Changkun Mao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
2
|
Wang Y, Chen G, Zhou N, Huang X. A new classification of mandible defects and condyle changed after mandible reconstruction with FFF. Heliyon 2024; 10:e25831. [PMID: 38384523 PMCID: PMC10878914 DOI: 10.1016/j.heliyon.2024.e25831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives To explore a new classification of mandibular defects and changes in the preserved condyle after mandibular reconstruction with free fibular flap(FFF). Study design We reviewed patients who underwent mandibular reconstruction with FFF from 2015 to 2021 and classified the mandibular defects into five categories: classⅠ(unilateral-mandibular excluding condyle), classⅡ(unilateral-mandibular including condyle), classⅢ(bilateral-mandibular excluding condyle), classⅣ(bilateral-mandibular including one condyle), and classⅤ(bilateral-mandibular including both condyles). Cone Beam Computed Tomography (CBCT) data were collected preoperatively(T0), at 7-10 postoperative days(T1), 6 postoperative months(T2), and 1 postoperative year(T3). We calculated the condylar surface area, volume, and displacement. Results 62 cases were collected. The condylar surface areas and volumes in T2 and T3 values were lower than those of T0 and T1(P < 0.01) The condylar displacement was the lowest in ClassI and the largest in ClassⅣ(P < 0.01), while no significant differences in classesⅠ-Ⅲ(P < 0.05). Displacement during T1-T0 was greater than that during T2-T0 and T3-T0(P < 0.05). Conclusion Mandibular reconstruction with FFF results in displacement and alteration of the condyle within a time interval, and this alteration stabilizes after 6 months. Mandibular defects that do not reach the midline, surgical alteration to preserve the condyle are not required. However, when the defects cross the midline, the condyle should be preserved as much as possible.
Collapse
Affiliation(s)
- Yaxi Wang
- Guangxi Medical University, Nanning, 530021, PR China
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Guangxi Medical University, Nanning, 530021, PR China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, 530021, PR China
| | - Guosheng Chen
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Guangxi Medical University, Nanning, 530021, PR China
| | - Nuo Zhou
- Guangxi Medical University, Nanning, 530021, PR China
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Guangxi Medical University, Nanning, 530021, PR China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, 530021, PR China
| | - Xuanping Huang
- Guangxi Medical University, Nanning, 530021, PR China
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Guangxi Medical University, Nanning, 530021, PR China
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Clinical Research Center for Craniofacial Deformity, Nanning, 530021, PR China
| |
Collapse
|
3
|
Huang WH, Xu LY, Chen SS, Chen ZQ, Cui X, Zhou CM. The effect of scrotal versus inguinal orchiopexy on the testicular function of children with clinically palpable, inguinal undescended testis: a randomized controlled trial. Asian J Androl 2023; 25:745-749. [PMID: 37282382 DOI: 10.4103/aja202314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/06/2023] [Indexed: 06/08/2023] Open
Abstract
To compare the impact of the scrotal vs inguinal orchidopexy approach on the testicular function of infants with cryptorchidism, a randomized controlled trial was conducted involving boys who were 6-12 months old at surgery and were diagnosed with clinically palpable, inguinal undescended testis. Between June 2021 and December 2021, these boys at Fujian Maternity and Child Health Hospital (Fuzhou, China) and Fujian Children's Hospital (Fuzhou, China) were enrolled. Block randomization with a 1:1 allocation ratio was employed. The primary outcome was testicular function assessed by testicular volume, serum testosterone, anti-Müllerian hormone (AMH), and inhibin B (InhB) levels. Secondary outcomes included operative time, amount of intraoperative bleeding, and postoperative complications. Among 577 screened patients, 100 (17.3%) were considered eligible and enrolled in the study. Of the 100 children who completed the 1-year follow-up, 50 underwent scrotal orchidopexy and 50 underwent inguinal orchidopexy. The testicular volume, serum testosterone, AMH, and InhB levels in both groups increased markedly after surgery (all P < 0.05), but there were no apparent differences between groups at 6 months and 12 months after operation (all P > 0.05). No differences between the scrotal and inguinal groups were noted regarding the operative time ( P = 0.987) and amount of intraoperative bleeding ( P = 0.746). The overall complication rate (2.0%) of the scrotal group was slightly lower than that of the inguinal group (8.0%), although this difference was not statistically significant ( P > 0.05). Both scrotal and inguinal orchiopexy exerted protective effects on testicular function in children with cryptorchidism, with similar operative status and postoperative complications. Scrotal orchiopexy is an effective alternative to inguinal orchiopexy in children with cryptorchidism.
Collapse
Affiliation(s)
- Wen-Hua Huang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, China
| | - Long-Yao Xu
- Department of Urinary Surgery, Fujian Children's Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China
| | - Shu-Shen Chen
- Department of Urinary Surgery, Fujian Children's Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China
| | - Zhi-Qiang Chen
- Department of Urinary Surgery, Fujian Children's Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China
| | - Xu Cui
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, China
| | - Chao-Ming Zhou
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, China
| |
Collapse
|
4
|
Guo Q, Zhang Y, Lai H, Zhong W, Qiu J, Wang D. Laparoscopic assisted trans-scrotal orchiopexy versus traditional orchiopexy for inguinal cryptorchidism: a retrospective study based on 154 patients. BMC Urol 2023; 23:84. [PMID: 37149558 PMCID: PMC10164302 DOI: 10.1186/s12894-023-01244-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the clinical effect of laparoscopic assisted trans-scrotal orchiopexy versus traditional orchiopexy for inguinal cryptorchidism. METHODS A retrospective analysis of cryptorchidism patients who were admitted to our hospital from July 2018 to July 2021. The patients were divided into the laparoscopic assisted trans-scrotal surgery group (n = 76) and the traditional surgery group (n = 78) according to the surgical method. RESULTS All patients were successfully operated. There was no significant difference in operation time between the laparoscopic assisted trans-scrotal group and the traditional group (P>0.05). Although there was no significant difference in the postoperative hospital stay between the two groups, the time of postoperative hospital stay of the laparoscopic assisted trans-scrotal surgery group was lower than that in the traditional surgery group (P = 0.062). Additionally, there was no significant difference in discharge rate on the first day after surgery between the two groups, but the discharge rate on the first day after surgery was more than 90% in both groups. In terms of postoperative complications, there were no cases of testicular retraction, testicular atrophy, inguinal hernia, or hydrocele that occurred in both groups. There was no significant difference in the incidence of scrotal hematoma between the two groups(P>0.05). Although there was no significant difference in the incidence of poor wound healing between the two groups(P>0.05), the incidence in the laparoscopic assisted trans-scrotal surgery group was lower than that in the traditional surgery group (2.6% vs. 6.4%). CONCLUSION Laparoscopic assisted trans-scrotal surgery is as safe and effective method as traditional surgery for patients with inguinal cryptorchidism, and could also provide a good appearance.
Collapse
Affiliation(s)
- Qiang Guo
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-sen University, No 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong Province, China
| | - Yifei Zhang
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-sen University, No 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong Province, China
| | - Huajian Lai
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-sen University, No 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong Province, China
| | - WenWen Zhong
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-sen University, No 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong Province, China
| | - Jianguang Qiu
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-sen University, No 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong Province, China
| | - Dejuan Wang
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-sen University, No 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong Province, China.
| |
Collapse
|
5
|
He TQ, Tong FY, Wang Z, Liu Y, Hu JJ, Chen YF, Tu L, He J, Zhao YW. Clinical Efficacy of Laparoscopic Orchiopexy With the Modified Prentiss Maneuver for Non-palpable Testis Near the Internal Ring. Front Pediatr 2022; 10:906739. [PMID: 35769212 PMCID: PMC9235851 DOI: 10.3389/fped.2022.906739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare the clinical efficacy and safety of laparoscopic orchiopexy with the modified Prentiss maneuver (LOMPM) and laparoscopic trans-inguinal orchiopexy (LTIO) for the treatment of non-palpable testis (NPT) <1 cm from the internal ring. METHODS Children with unilateral NPT who underwent laparoscopic orchiopexy at our center between February 2018 and January 2021 were retrospectively analyzed. According to the surgical method, they were divided into LOMPM and LTIO groups. The operation time, postoperative pain degree, postoperative complications and follow-up results were compared between the two groups. RESULTS A total of 98 patients were included in this study, including 41 cases in the LOMPM group and 57 cases in the LTIO group. All patients underwent successful surgery. The LOMPM group was superior to the LTIO group in terms of postoperative testicular position (lower scrotm: 90.2 vs. 71.9%, P = 0.026). There were no significant differences in operation time, postoperative pain score, and complications between the two groups. Preoperative testicular volume, postoperative testicular volume, and testicular growth rate in the LOMPM group were comparable to those in the LTIO group. There were no testicular atrophy, inguinal hernia and hydrocele in both groups after operation. CONCLUSIONS LOMPM was comparable in safety to LTIO, but LOMPM had a good post-operative testicular position, and was suitable for the treatment of NPT near the internal ring.
Collapse
Affiliation(s)
- Tian-Qu He
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Fang-Yun Tong
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Zhi Wang
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Yu Liu
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Jian-Jun Hu
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Yi-Fu Chen
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Lei Tu
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Jun He
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Yao-Wang Zhao
- Department of Urology, Hunan Children's Hospital, Changsha, China
| |
Collapse
|
6
|
Anand S, Krishnan N, Pogorelić Z. Utility of Laparoscopic Approach of Orchiopexy for Palpable Cryptorchidism: A Systematic Review and Meta-Analysis. CHILDREN-BASEL 2021; 8:children8080677. [PMID: 34438568 PMCID: PMC8392196 DOI: 10.3390/children8080677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
Background: Traditional open orchiopexy is still a standard of treatment for palpable undescended testicles. Recently several authors reported successful results using a laparoscopic approach in the treatment of palpable cryptorchidism. The present systematic review and meta-analysis investigated the utility of laparoscopic orchiopexy for palpable cryptorchidism. Methods: Scientific databases (PubMed, Scopus, Web of Science, and EMBASE) were systematically searched for relevant articles using the following terms: (palpable cryptorchidism or palpable undescended testes) AND (laparoscopic orchiopexy or laparoscopic orchiopexy). The inclusion criteria were all children with unilateral or bilateral palpable undescended testes who underwent laparoscopic orchiopexy (LO) compared to children who underwent conventional open orchiopexy (CO). The main outcomes were the proportion of children requiring redo-orchiopexy and the incidence of postoperative complications. Secondary outcomes were duration and the cost of surgery. Results: The final meta-analysis included five studies involving 705 children; LO, n = 369 (52.3%) and CO, n = 336 (47.7%). The majority of the included patients had unilateral palpable cryptorchidism. No significant differences were found in regard to average age at the time of surgery and follow-up periods between the investigated groups. No statistically significant differences were found in regard to redo-orchiopexy rates (RR = 0.22, 95% CI 0.03–1.88, p = 0.17), early complications (RR = 0.66, 95% CI 0.21–2.08, p = 0.48) and incidence of testicular atrophy (RR = 0.36, 95% CI 0.03–3.88, p = 0.40). No significant differences in the operative duration were observed among the groups. Laparoscopy was associated with higher costs in most of the studies. Conclusion: LO is safe and effective in children with palpable cryptorchidism. The rates of redo-orchiopexy as well as an incidence of early complications and testicular atrophy rates are comparable to CO.
Collapse
Affiliation(s)
- Sachit Anand
- Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India;
| | - Nellai Krishnan
- Department of Pediatric Surgery, AIIMS, New Delhi 110029, India;
| | - Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, 21000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21-556654
| |
Collapse
|