Authors: Anies Mahomed, Mohanned Al Ghamas, Nourah ALSaleh, Osama Bawazir, Nadeem Kawsar.
Background: A minority of undescended testes are intra-abdominal. Controversy still exists over the optimal laparoscopic technique to mobilize these gonads. The gubernaculum sparing, laparoscopic assisted, staged Fowler Stephens (FS) approach, has been shown to be highly effective in restoring unilateral intra-abdominal testes (IAT) into the scrotum. Crucial to success is the preservation of an adequate arterial supply. The outcome of this technique for bilateral IAT has not previously been independently reported.
Aim: To assess the outcome of gubernaculum sparing laparoscopic assisted FS orchidopexy technique for bilateral intra-abdominal testes.
Method: Over a 13-year period (2005-18), 36 cases of impalpable testes subjected to laparoscopy under a single surgeon’s care were prospectively recorded on an Excel spreadsheet. Six cases with bilateral intra-abdominal testicles were the focus of this study. Demographic details, operative findings, details of intervention and outcome were recorded. Follow up was for a period of at least a year.
Results: Six cases of mean age 3.4 years (range 1.1-10.4) underwent bilateral orchidopexy. Three cases had significant underlying comorbidities and were late referrals. All interventions aside from one with small bowel injury were day procedures. At follow up all patients had a successful outcome with palpable testes in the scrotum bilaterally.
Conclusion: This study confirms the effectiveness of a staged gubernaculum sparing, laparoscopic assisted FS procedure for bilateral intra-abdominal testes. The results match those of unilateral intra-abdominal testicles subjected to the same procedure. Preservation of collaterals in a gubernaculum-sparing approach may explain the excellent results seen in this and prior series.
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