Anatomical Laparoscopic Orchiopexy and Hybrid Transscrotal Orchiopexy for High Inguinal Undescended Testis: A Novel and Interfascial Technique
Weiguang ZhaoPeng SunJinjin XieJunjie SunWei ZhouZhilin YangYibin FanJianchun YinQitao XuYingtian ZhangGuanglun ZhouJunhai JiangShoulin Li
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Background: In traditional laparoscopic orchiopexy for inguinal undescended testis (UDT) surgery, the testicles are pulled back into the abdominal cavity by grasping and cephalad retracting the testicle and the cord. If this fails, a subsequent open inguinal incision is made to complete orchiopexy. To improve the orchiolysis and avoid extra open inguinal incision, we describe our early experience with and illustrate the surgical procedure of a novel anatomical laparoscopic orchiopexy (ALO) and hybrid transscrotal orchiopexy as required in high palpable UDT. Methods: From March 2018 to April 2020, ALO was performed in 140 consecutive patients (158 testes) with high inguinal UDT. After blunt and bloodless dissection of the inter-tunica vaginalis-cremasteric fascia plane, tunica vaginalis enveloping the testis was brought into the abdominal cavity as a whole. When the tunica vaginalis was unable to be brought into the abdominal cavity, given that the orchiolysis had already been partially carried out, the testis could be brought out of the external ring and descended when converting to transscrotal surgery. Results: The mean age in this study was 1.88 years (standard deviation ±1.95). The position of the testis assessed at surgery was peeping (58, 36.7%) and canalicular (100, 63.3%). In 128 testes (81.1%), ALO brought the UDT into the abdominal cavity; the remaining 30 testes (18.9%) required a hybrid transscrotal technique. All testes were descended without conversion to open inguinal procedure. The mean operative time was 43.9 ± 9.2 minutes. All patients had follow-up within a median of 17.8 months, with satisfactory results in relation to viability and location of the testis. Conclusions: ALO was shown to be not only safe, feasible, and effective for high inguinal UDT but also facilitated subsequent hybrid transscrotal orchiopexy; when the testis failed to be pulled into the abdominal cavity, the conversion to open inguinal orchiopexy could be obviated.Keywords:
Orchiopexy
Tunica vaginalis
Abdominal cavity
Spermatic cord
Hydrocele
Tunica vaginalis
Hydrocele
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To assess whether incision of the tunica vaginalis of the ipsilateral testis during the Palomo procedure affects the incidence of post-operative hydrocele.Forty-two patients with varicocele were treated between 1992 and 1996, all undergoing the Palomo procedure. In 15 patients, incision of the tunica vaginalis of the ipsilateral testis was performed with the Palomo procedure, to prevent the formation of hydrocele. All patients were followed at regular intervals, for 3 months to 4 years.Of 27 patients who underwent the Palomo procedure alone, four developed post-operative hydrocele requiring operation. None of those who underwent incision of the tunica vaginalis with the Palomo procedure developed a hydrocele. The duration of hospital stay was the same in both groups (mean 2.5 days). During the follow-up, there was no difference in the size of the testes, as assessed with the Prader orchidometer, between the two groups.Incision of the tunica vaginalis of the ipsilateral testis in addition to the Palomo procedure prevents the development of post-operative hydrocele and causes no adverse sequelae.
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Surgicalhe CT appearance of hydrocele of the tunica vaginalis is described. Embryology of testicular descent and the anatomic relationship of the testis to the tunica vaginalis are described.
Tunica vaginalis
Hydrocele
Tunica
Tunica media
Descent (aeronautics)
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The aim was to evaluate the value of ultrasound diagnosis of spermatic cord hydrocele as a cause of inguinal swelling or mass in children. Clinical and ultrasound (US) findings and surgical procedures of 27 children with spermatic cord hydrocele were reviewed. All children, except one, were referred for US because of suspected inguinal hernia, hydrocele or inguinal mass. In one child, the US examination was performed to confirm the diagnosis of a spermatic cord hydrocele. An encysted hydrocele was diagnosed in 24 out of 27 cases, whereas a funicular type of spermatic cord hydrocele was found in the remaining 3 cases. Internal septa were seen within the fluid mass in four patients. 23 children underwent surgical exploration that confirmed the US diagnosis. Three children with encysted-type hydrocele were only followed clinically and by US, and one was lost from follow-up. US examination is a very sensitive and accurate method for diagnosis of this entity and for exclusion of other lesions in this region.
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Hydrocele of spermatic cord is caused by defect in closure of the processus vaginalis, as the testicles descend into the scrotum during foetal development. It usually occurs in infancy and childhood. There are two types of hydrocele of spermatic cord. Encysted type is caused by defective closure at both proximal and distal ends of processus vaginalis and it does not communicate with the peritoneal cavity. Funicular type is caused by defective closure of only distal end of tunica vaginalis and it communicates with the peritoneal cavity. The encysted type can be confused clinically with incarcerated inguinal hernia, inguinal lymphadenopathy, undescended testis and primary tumours of cord like lipoma. We are presenting a case of encysted hydrocele of spermatic cord in a 60-year-old male, which clinically mimicked incarcerated inguinal hernia.
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Tunica vaginalis
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AIM To improve the outcome and decrease the complication after the operation of the hydrocele of testis.METHODS 26 patients were treated with the modified method:placed the testis outside the tunica vaginalis with Listerism to destroyed the secretion function of the tunica vaginalis.RESULTS After 6 months to 3 years follow-up we have got a good results,there are no complications.CONCLUSION It's a simple and safe method to treat the hydrocele.
Tunica vaginalis
Hydrocele
Tunica
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Tunica vaginalis
Hydrocele
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Tunica vaginalis
Hydrocele
Tunica media
Tunica
Tunica albuginea (penis)
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Objective:To explore the method of treating hydrocele of tunica vaginalis in infant.Method:The clinical data of 155 cases (from Oct.2003 to Dec.2009) with hydrocele of tunica vaginalis were treated by mini-incision was analyzed retrospectively.Among them,145 male,all were unilateral;10 female cases,9 were unilateral,1 were bilateral.Result:155 cases were cured without complication and 1 case recurrence occurred.Conclusion:Mini-incision in treating the hydrocele of tunica vaginalis has following advantages:low cost,convenience with minimal invasion,low recurrence rate.
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Tunica
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Objective:To explore a new method of laparoscopy in treatment of indirect inguinal hernia and the hydrocele of tunica vaginalis in children.Methods:One hundred and eighty cases with indirect inguinal hernia and the hydrocele of tunica vaginalis were treated by laparoscopic surgery.Among them,150 cases had indirect inguinal hernia(right:80 cases,left:40 cases,bilateral:30 cases),20 cases had contralateral latent hernia in the unilateral hernias,and 30 cases(right:20 cases,left:10 cases)with the hydrocele of tunica vaginalis.All patients underwent internal orifice high ligation with laparoscopy,and the hydrocele of tunica vaginalis was drawn out.Results:The average operative time was 5-10min in unilateral hernia and 10-20min in bilateral hernia.The mean postoperative hospitalization was 36h.Skin sutures were not required.All patients were followed-up for 6-24months(mean 12 months),and no complications and recurrence occurred.Conclusions:Laparoscopic high ligation surgery and removal of the hydrocele of tunica vaginalis is a simple,satisfactory,effective,and minimally invasive surgical method.It causes no infection in the wound cut,scrotum and testis,no nerve damage,no pain and numb in lower abdomen.
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Ligature
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