One stage laparoscopic Fowler-Stephens orchiopexy in Pre-School Age Children

Abstract

There is a lot of controversy regarding the best management for IAT. Fowler Stephens orchiopexy still remains the most popular procedure undertaken by most surgeons. However, there is still a lack of strong, clear evidence in favour of either the one stage or two stage FSO. Testicular atrophy is the main complication of such a procedure. One stage laparoscopic FSO holds a comparatively higher testicular atrophy rate than the two stage operation. Expected postoperative testicular position is relatively the same though where both the one stage and two stage operations can be expected to achieve a scrotal position for the IAT should it remain viable. A high scrotal position is still an acceptable position for IAT with short spermatic cord following one stage laparoscopic FSO. No individual patient factors were significantly associated with risk of testicular atrophy or ascent. There is also no increased complication rate with the one stage laparoscopic FSO. One stage laparoscopic FSO holds some small added advantages over two stage operation but this still does not justify it as it holds a higher testicular atrophy rate. Those advantages include avoiding a repeat anaesthesia, the potentially difficult dissection associated with a re-operation, the further waiting period of a 3-6 months for the second stage and the further cost of a second laparoscopy An IAT with short spermatic cord can withstand a one stage laparoscopic FSO and still maintain a normal blood flow to it. Normal testicular blood flow RI was detected in all clinically assumed viable testes. It is still to be proven whether the descent of the IAT after one stage or two stage laparoscopic FSO will halt the deterioration in fertility of the IAT. There is an important yet limited role for ultrasound in confirming testicular viability or atrophy. If a testis can be felt clinically in the scrotum at the 6 mo F/P, there is no need for further radiological investigations to confirm its viability. Both conventional and Spectral Doppler U/S will not add more than what is already known by examination. However, if a testis is not felt clinically in the scrotum at the 6 mo F/P, a conventional U/S is still important to rule out that it might have retracted upwards and ascended into the muscular or subcutaneous track for which it was rerouted from the abdomen. If a testicular nubbin is seen by ultrasound, Spectral U/S will almost always confirm that there is significantly dampened or absent blood flow to it, and no spectral waveform will be able to be drawn.