Diagnostic laparoscopy revealed average size right testis 2 cm higher than the internal inguinal ring
Dr Mohamed. Would you consider microvascular anastomosis to bring this testes down in one stage; (Silber Kelly's method i guess)
About direct Orchidopexy: Single Stage Stephen Fowler has a 30% rate of loss of testes in Single stage. Virtually given up. The trick is that during laparasocopy if the testes could be swung upto the opposite internal ring, one has a very good chance of bring down same in One Stage. Otherwise its best to clipp the vessels within 1 inch above the testes; I would go to extend of clipping and transecting them so that the edges of vessels move apart to avoid failure of first stage of S F. Then over four to six months, the testes could be mobilized over the leash of peritoneum and brought down into scrotum.
I agree with you: moving the testis to the other ring is a good sign to predict successful direct orchiopexy. Testis 2 cm or less close to internal ring can be also amenable for direct orchiopexy especially if it is not stuck to the posterior peritoneum. Using printess technique ( creating new ring medial to medial umbilical ligament ) is also helpful for successful direct orchiopexy
Average size testis should be saved. 2cm to deep ring is not high. You should be able to bring it down after a little mobilisation of the lateral peritoneal attachment.Good luck.
I agree. Two cm within deep ring should be amenable to inguinal exploration' meticulous dissection and standard orchidopexy. Medialisation (to inf epigastric vessels) would add to length as well. At worst one could fix it to pubic tubercle (marking it with a non-absorbale suture) and go in for second stage at later date (3-4 months). Although some say that there is unlikely to be much viable testicular tissue whenc attempted in two stage open approach!!
- Badges
- Science topic
- Similar topics
- Biological Science
- Microbiology
- Virology
- Virus