BENEFITS OF LAPAROSCOPY AND THE JONES TECHNIQUE FOR THE NONPALPABLE TESTIS

Purpose: We report on the role of diagnostic laparoscopy combined with the Jones suprainguinal approach to orchiopexy in the treatment of ab dominal, testes.Materials and Methods: A retrospective review was done of 209 boys with 265 cryptorchid testes who underwent orchiopexy betw een January 1994 and March 1996. A subset of patients with nonpalpable testis underwent diagnostic laparoscopy and according to the laparosc opic findings either standard inguinal or suprainguinal extraperitonea l orchiopexy. Results: Of 209 patients 47 had 63 impalpable testes. La paroscopy was done on 31 patients (42 testes), Findings at laparoscopy revealed 29 (69%) abdominal, 7 (17%) intracanalicular and 6 (14%) van ishing testes. A satisfactory result with scrotal position of the test is and no atrophy was obtained in 18 of 19 patients operated via the J ones approach combined with diagnostic laparoscopy. The only patient w ith unsatisfactory result underwent ligation of the spermatic vessels at the time of operation. In contrast, satisfactory results were achie ved for only 7 of 10 intraabdominal testes after diagnostic laparoscop y and standard inguinal orchiopexy despite universal spermatic vessel ligation. Of these 10 testes 2 ended in an inguinal location and 1 atr ophied. Conclusions: Laparoscopy was helpful in determining surgical a pproach in most cases. The suprainguinal approach allowed most abdomin al testes to be placed in the scrotum without vascular ligation.