LAPAROSCOPY IN THE MANAGEMENT OF THE IMPALPABLE UNDESCENDED TESTIS

Background This study evaluates the role of laparoscopy for managing t he intra-abdominal testis. Methods Over 30 months, 48 children (six wi th previous groin explorations) underwent laparoscopy for a unilateral impalpable undescended testis. The patients' age ranged from 1 to 9 y ears. Results Eleven children required insertion of 'working ports' fo r mobilization of obscuring colon before the diagnosis could be establ ished. Twenty-eight children had an absent testis. In nine, vas and ve ssels 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 low er half of the scrotum and six in the upper half. The remaining ten ch ildren underwent a laparoscopic two-stage Fowler-Stephens operation. A t 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. Conclusio n In the majority of cases, laparoscopy obviates the need for groin ex ploration. Technically a first-stage Fowler-Stephens procedure can be performed easily and effectively via the laparoscope. However, the sec ond-stage Fowler-Stephens procedure or single-stage orchidopexy requir es laparoscopic skills and may not necessarily provide sufficient leng th to the testicular attachment.