How is standard abdominal orchiopexy performed for the treatment of cryptorchidism with nonpalpable testis?

Updated: Dec 17, 2020
  • Author: Joel M Sumfest, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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For standard abdominal orchiopexy, choose between an extended inguinal versus an abdominal (vertical midline or Pfannenstiel) incision. This procedure yields an 81% success rate, defined as scrotal testis without atrophy. Orchiopexy to correct a so-called peeping testis at the internal inguinal ring yields a success rate of 82%. If the testis is in the abdominal cavity, the success rate is 74%. The surgeon may proceed to other techniques for orchiopexy (ie, 2-stage, artery ligation) depending on testis mobility.

The 2-stage orchiopexy can be used after extensive cord mobilization; however, spermatic cord injury is a risk during the second procedure. The success rate is 73%.

The single-stage Fowler-Stephens procedure must be planned ahead to avoid devascularization of the secondary blood supply from the vas deferens and the cremaster muscles. It can be performed using open or laparoscopic technique. The success rate is 67%. The 2-stage Fowler-Stephens procedure theoretically allows improved collateral blood supply, but a second stage is required. It may also be performed with an open or laparoscopic technique. The success rate is 77%. A literature review reveals no statistically significant difference between success rates of 1-stage versus 2-stage Fowler-Stephens orchidopexies.

Shehata et al describe an alternative to the two-stage Fowler-Stephens technique for patients with a high intra-abdominal testis, two-stage laparoscopic traction orchiopexy, which permits elongation of the testicular vessels without division. In the first stage, the testis is fixed to a point 1 inch above and medial to the contralateral anterior superior iliac spine for 12 weeks. Subdartos orchiopexy is done at the second stage. In their study of boys 6 months to 9 years of age, scrotal testes were achieved in 105 (84%) of 125 cases. [68]

For laparoscopy-assisted orchiopexy (LAO), mobilize the testicular vessels laparoscopically up to the renal level to avoid tension for a classic open inguinal orchiopexy. Increased magnification aids in dissection. Make abdominal port incisions and an open inguinal incision.

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