A comparative study of two techniques of laparoscopic orchiopexy for intra-abdominal testis
DOI:
https://doi.org/10.18203/2349-2902.isj20253824Keywords:
Intra-abdominal testis, Shehata technique, Fowler-Stephens laparoscopic orchiopexyAbstract
Background: This study compares Fowler-Stephens and Shehata techniques for intra-abdominal testes, evaluating outcomes in testicular viability, positioning, and size to guide optimal surgical management.
Methods: This retrospective study analyzed patients undergoing two-stage Shehata or Fowler-Stephens laparoscopic orchiopexy (FSLO) for intra-abdominal testis (August 2016-September 2019), collecting baseline characteristics and postoperative outcomes for comparison.
Results: A total of 20 patients who underwent two-stage laparoscopic orchiopexy were included in this study. The patients were divided into two groups based on the technique used: the Shehata group (n=11) and the FSLO group (n=9), with each group including one case of bilateral intra-abdominal testes. In the FSLO group, testicular atrophy was observed in 30% (3/10) of the cases, whereas in the Shehata group, no testicular atrophy was observed (p=0.011). In the Shehata group, 75% (9/12) of the testes achieved a normal scrotal position, whereas in the FSLO group, 60% (6/10) achieved a normal scrotal position (p=0.001). 75% of the testes had a normal size in the Shehata group, whereas only 30% had a normal size in the FSLO group (p=0.001). In the FSLO group, the scrotal position was more successfully achieved in children over 4 years (p=0.006).
Conclusions: The Shehata technique better preserves vascularity and achieves scrotal positioning in children under 4 years, while FSLO shows superior outcomes in older children, making age a key factor in technique selection for intra-abdominal testis.
Metrics
References
Arena S, Impellizzeri P, Perrone P, Scalfari G, Centorrino A, Turiaco N, et al. Is inguinal orchidopexy still a current procedure in the treatment of intraabdominal testis in the era of laparoscopic surgery? J Pediatr Surg. 2017;52(4):650-2. DOI: https://doi.org/10.1016/j.jpedsurg.2016.08.030
Sheikh A, Mirza B, Ahmad S, Ijaz L, Kayastha K, Iqbal S. Laparoscopic management of 128 undescended testes: Our experience. Afr J Paediatr Surg. 2012;9:106-8. DOI: https://doi.org/10.4103/0189-6725.99393
Papparella A, Umano GR, Romano M, Delehaye G, Cascone S, Trotta L, et al. In which patients and why is laparoscopy helpful for the impalpable testis? In Minim Invasive Surg. 2022;2022:1564830. DOI: https://doi.org/10.1155/2022/1564830
Al Hindi S, Khalaf Z. The outcome of assisted laparoscopic-assisted orchidopexy in very young children: A single hospital experience. J Pediatr Urol. 2021;17(4):536.e1-536.e7. DOI: https://doi.org/10.1016/j.jpurol.2021.03.004
Tian Q, Zhao X, Zhang C, Yu K, Erhu F, Zhou X, et al. Compared outcomes of high-level cryptorchidism managed by Fowler-Stephens orchiopexy versus the Shehata technique: A systematic review and meta-analysis. J Pediatr Urol. 2023;19(3):313-9. DOI: https://doi.org/10.1016/j.jpurol.2023.02.025
Shehata S, Hadziselimovic F, Khater D, Kotb M. The management of intraabdominal testis: A survey of the World Federation of associations of Pediatric Surgeons (WOFAPS) practices. Front Pediatr. 2022;10:928069. DOI: https://doi.org/10.3389/fped.2022.928069
Abouheba MAS, Younis W, Elsokary A, Roshdy W, Waheeb S. Early clinical outcome of staged laparoscopic traction orchidopexy for abdominal testes. J Laparoendosc Adv Surg Tech A. 2019;29(4):531-7. DOI: https://doi.org/10.1089/lap.2018.0171
Gonzalez KW, Dalton BG, Snyder CL, Leys CM, St Peter SD, Ostlie DJ. The anatomic findings during operative exploration for non-palpable testes: A prospective evaluation. J Pediatr Surg. 2016;51(1):128-30. DOI: https://doi.org/10.1016/j.jpedsurg.2015.10.031
Shreyas K, Rathod KJ, Sinha A. Management of high inguinal undescended testis: A review of the literature. Ann Pediatr Surg. 2021;17(1):42. DOI: https://doi.org/10.1186/s43159-021-00107-6
Ang CW, Forrest J. Diagnostic laparoscopy and management of the impalpable testis—A review of 10 years practice at a non-pediatric specialist center. J Pediatr Urol. 2008;4(3):214-7. DOI: https://doi.org/10.1016/j.jpurol.2007.11.004
Shehata SM, Shehata SMK, A Baky Fahmy M. The intra-abdominal testis: Lessons from the past, and ideas for the future. Pediatr Surg Int. 2013;29(10):1039-45. DOI: https://doi.org/10.1007/s00383-013-3406-5
Brohi AB, Mengal N. Laparoscopic single-stage vessel sparing orchiopexy. J Surg Pakistan. 2017;22(4):133-7. DOI: https://doi.org/10.21699/jsp.22.4.7
Sepúlveda X, López Egaña PJ. Current management of non-palpable testes: A literature review and clinical results. Transl Pediatr. 2016;5(4):233-9. DOI: https://doi.org/10.21037/tp.2016.10.06
Shehata S, Shalaby R, Ismail M, Abouheba M, Elrouby A. Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique): Stretching the limits for the preservation of testicular vasculature. J Pediatr Surg. 2016;51(2):211-5. DOI: https://doi.org/10.1016/j.jpedsurg.2015.10.063
Liu J, Tang R, Wang X, Sui B, Jin Z, Xu X, et al. Comparison of two types of staged laparoscopic orchiopexy for high intra-abdominal testes in children: A retrospective study from a single center. Front Pediatr. 2021;9:677955. DOI: https://doi.org/10.3389/fped.2021.677955
Tseng CS, Huang KH, Kuo MC, Hong CH, Chen CH, Lu YC, et al. The impact of primary location and age at orchiopexy on testicular atrophy for congenital undescended testis. Sci Rep. 2019;9(1):9489. DOI: https://doi.org/10.1038/s41598-019-45921-6
Roy C, Cullis PS, Clark C, Munro FD. Retrospective analysis of testicular outcomes following laparoscopic two-stage Fowler Stephens orchidopexy. J Pediatr Surg. 2020;55(2):300-3. DOI: https://doi.org/10.1016/j.jpedsurg.2019.10.030
David VL, Sosoi A, Ciornei B, Stanciulescu C, Bortea I, Popoiu C, et al. Laparoscopic staged spermatic vessel-sparing procedure for intra-abdominal undescended testis. J Ped Endosc Surg. 2020;2(3):111-6. DOI: https://doi.org/10.1007/s42804-020-00057-7
Alam A, Delto JC, Blachman-Braun R, Wayne G, Mittal AG, Castellan M, et al. Staged Fowler-Stephens and single-stage laparoscopic orchiopexy for intra-abdominal testes: Is there a difference? A single institution experience. Urology. 2017;101:104-10. DOI: https://doi.org/10.1016/j.urology.2016.09.060
Shiraishi K, Takihara H, Matsuyama H. Testicular temperature and the effects of orchiopexy in infants with cryptorchidism. J Urol. 2021;206(4):1031-7. DOI: https://doi.org/10.1097/JU.0000000000001896
Shehata S. Laparoscopic management of intra-abdominal testis (Shehata technique). In Lacher, M., Muensterer, O.J. (eds) Video Atlas of Pediatric EndoSurgery (VAPE). Springer, Berlin. 2021. DOI: https://doi.org/10.1007/978-3-030-58043-8_37
Varga A, Kardos D, Radványi Á, Vajda P, Sasi Szabó L, Kovács T. Medium-term results of staged laparoscopic traction orchiopexy for intra-abdominal testes: A multicenter analysis. J Pediatr Surg. 2023;58(10):2020-6. DOI: https://doi.org/10.1016/j.jpedsurg.2023.04.013
Downloads
Published
How to Cite
Issue
Section
