Abstrait

Single vs. two stage Laparoscopic Stephen Fowler's orchidopexy. A prospective Study

Raashid Hamid*, Waseem Jan Shah, Akshit Sudanshu, Idrees Bashir, Tariq A Wani, Shoib Ahmad, Gowhar N Mufti, Nisar A Bhat, Ajaz A Baba

Background: Laparoscopic Stephen Fowler’s Orchidopexy (Lap SFO) is routinely performed worldwide procedure for non-palpable testis. Some institutions prefer two stages Lap SFO and in some institute single stage SFO is performed. There has been less data regarding the comparison of single vs. two stages Lap. SFO in the literature. We, in our study attempted to compare these two procedures respectively. Methods: Unilateral non-palpable UDT were included in this study. Only testes which were within 2.5 cm of Deep Inguinal Ring (DIR) were included. Patients were randomly divided into two groups ‘A’ and ‘B’. In group ‘A’ patients, laparoscopic ligation of the vessel and dissection of the testicular pedicle by preserving a strip of peritoneum on both side of vas was performed. The testis was delivered through a trochar medial to Inferior Epigastric Vessel (IEV) and fixed in subdortos pouch. In group B patients, laparoscopic ligation of the vessel was performed in stage I of operation. In group ‘B’ stage II procedure was performed after 4 months. A strip of peritoneum on was preserved on both side of vas and vasal vessels. A trochar was inserted medial to the IEV and testis delivered in scrotum and fixed in subdortos pouch. The size of the testis was followed with USG and successful result was considered when testis was located deep in the scrotum. Procedure was considered failure if testis had altered echogenesity and testis was located above mid-scrotal point. Results: Only unilateral cases of Non palpable Undescended Testis (NP UDTS) were included in the study. In group ‘A’ 28 patients. Underwent single stage SFO, while as in group ‘B’ 30 patients underwent staged SFO. Average age was 3.2 years ± 13 months in all 58 patients. The volume was followed at 1, 3, 6 monthly intervals after the operation. In group ‘A’ (20 out of 28) and group ‘B’ (26 out 30 patients) had testis located deep in scrotum were considered successful respectively. Overall success rate in group A and B was 71% and 86% respectively. In group ‘A’ and ‘B’ there were five and two cases of testicular atrophy respectively. This difference of success rate between the two groups was statistically significant. Conclusion: The success rate of two staged SFO is better than that of single stage SFO. While the need for the second anesthesia is avoided in single stage SFO, but we believe it should not be at the cost of non salvageablity of testicles. We propose that staged SFO is better than single stage.