Medium-Term Results of Staged Laparoscopic Traction Orchiopexy for Intra-abdominal Testes: A Multicenter Analysis

• Published in: Journal of pediatric surgery Vol. 58; no. 10; pp. 2020 - 2026
• Main Authors: Varga, Alexandra, Kardos, Dániel, Radványi, Ádám, Vajda, Péter, Sasi Szabó, László, Kovács, Tamás
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2023
• Subjects: Intra-abdominal testis; Shehata-technique; Staged laparoscopic traction orchiopexy; Staged laparoscopic traction orchiopexy; Intra-abdominal testis; Shehata-technique
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2023.04.013

Staged laparoscopic traction orchiopexy (SLTO) is a novel technique for the intra-abdominal testis (IAT) based on elongation of the testicular vessels without separating them. This multicenter study evaluated the medium-term results of this technique.
Data of SLTO performed in three pediatric surgical centers between 2013 and 2020 were analyzed retrospectively. In 2021, physical and Doppler ultrasound examinations were performed to determine the position and viability of testes. Success was defined as an intra-scrotal testicle without atrophy.
SLTO was performed on 48 cases (55 testes, 7 bilateral). Mean age at first stage was 2.9 (0.8–12.6) years. High intra-abdominal testes were found in 16.4% and in 60% morphological abnormalities were observed. To fix the testes to the abdominal wall monofilament suture was used in 67.3%, braided in 29.1%. Mean time between the two stages was 16.4 weeks; three testes required redo traction.
Perioperative complications occurred in 21 patients (38.2%) including insufficient fixation (11), testicular atrophy (4), wound complications (4), adhesion of the spermatic cords (1) and hydrocele (1). In case of insufficient fixation monofilament sutures were used in 90.9%.
In 2021 38 patients (43 testes) had physical and 36 patients (41 testes) had ultrasound examinations. Mean follow-up was 2.7 (0.34–7.9) years. Altogether five atrophies were identified, and three testicular ascents (7.0%) occurred. The overall success rate was 82.2%.
SLTO may be a feasible alternative to conventional treatments of IATs. Additionally, braided suture seems to be a better option to fix the testicle to the abdominal wall.
LEVEL IV.
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•What is currently known about this topic?•Surgical treatment of intra-abdominal testis is still challenging.•What new information is contained in this article?•According to this multicenter, retrospective study on the medium-term results of staged laparoscopic traction orchiopexy, this technique may be a feasible alternative to conventional treatments. Additionally, braided suture seems to be a better option to fix the testicle to the abdominal wall.