Laparoscopy in the management of the impalpable undescended testis

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Abstract
Background: This study evaluates the role of laparoscopy for managing the intra-abdominal testis. Methods: Over 30 months, 48 children (six with previous groin explorations) underwent laparoscopy for a unilateral impalpable undescended testis. The patients' age ranged from 1 to 9 years. Results: Eleven children required insertion of ‘working ports’ for mobilization of obscuring colon before the diagnosis could be established. Twenty-eight children had an absent testis. In nine, vas and vessels entered the internal ring. In 19, vas and vessels ended blindly above the internal ring. Twenty children had an intra-abdominal testis. Ten underwent a laparoscopic single-stage orchidopexy (eight without and two with ligation of vessels); at a minimum follow-up of 2 years, one testis in this group had atrophied, three were located in the lower half of the scrotum and six in the upper half. The remaining ten children underwent a laparoscopic two-stage Fowler–Stephens operation. At a minimum follow-up of 6 months, eight of these testes were palpable in the lower half and two in the upper half of the scrotum. Conclusion: In the majority of cases, laparoscopy obviates the need for groin exploration. Technically a first-stage Fowler–Stephens procedure can be performed easily and effectively via the laparoscope. However, the second-stage Fowler–Stephens procedure or single-stage orchidopexy requires laparoscopic skills and may not necessarily provide sufficient length to the testicular attachment.