Agrawal Amit, Joshi Milind, Mishra Pankaj, Gupta Rahul, Sanghvi Beejal, Parelkar Sandesh
Department of Pediatric Surgery, King Edward Memorial Hospital, Mumbai, India.
J Laparoendosc Adv Surg Tech A. 2010 Mar;20(2):183-5. doi: 10.1089/lap.2009.0111.
The length of testicular vessels is the main length-limiting factor to bring down the testes in the scrotum. Fowler and Stephen proposed the division of testicular vessels, high and as far from the testes as possible to maintain collateral blood supply, to treat high intra-abdominal testes. Cortesi introduced the diagnostic laparoscopy and Jorden first did the laparoscopic orchiopexy for nonpalpable testes. We had done Fowler-Stephen staged orchiopexy for high intra-abdominal testes, in which both stages were done laparoscopically.
In total, 17 testes of 13 patients had undergone laparoscopic staged Fowler-Stephen orchiopexy. The decision to perform a staged Fowler-Stephen orchiopexy was based on the distance of the testis from the deep inguinal ring on laparoscopy. If distance was more than 2.5 cm, then we proceeded to a laparoscopic staged Fowler-Stephen orchiopexy. In the first stage, testicular vessels were cauterized by bipolar diathermy. Laparoscopic second-stage Fowler-Stephen procedure was done 6 months after the first stage. Patients were regularly followed, and the success of the procedure was assessed by the size of the testes and the position in the scrotum. Testicular vascularity was assessed by color Doppler ultrasonography. There was no testicular atrophy on second stage and on follow-up. All testes were in the scrotum with good size on follow-up. There was no complication related to laparoscopy.
In cases of high intra-abdominal testes, the staged Fowler-Stephen procedure should be the procedure of choice. This procedure yields a high success rate. Transaction of vessels by bipolar diathermy is a very safe, cost-effective method.
睾丸血管的长度是将睾丸降至阴囊的主要长度限制因素。福勒和斯蒂芬提出将睾丸血管尽可能高位且远离睾丸进行分离，以维持侧支血供，用于治疗高位腹腔内睾丸。科尔泰西引入了诊断性腹腔镜检查，乔登首次对不可触及的睾丸进行了腹腔镜睾丸固定术。我们对高位腹腔内睾丸进行了福勒 - 斯蒂芬分期睾丸固定术，两期均通过腹腔镜完成。
13例患者的17个睾丸接受了腹腔镜分期福勒 - 斯蒂芬睾丸固定术。决定进行分期福勒 - 斯蒂芬睾丸固定术是基于腹腔镜检查时睾丸与腹股沟深环的距离。如果距离超过2.5厘米，那么我们就进行腹腔镜分期福勒 - 斯蒂芬睾丸固定术。在第一阶段，用双极电凝烧灼睾丸血管。腹腔镜第二阶段福勒 - 斯蒂芬手术在第一阶段6个月后进行。对患者进行定期随访，并通过睾丸大小和阴囊内位置评估手术成功率。通过彩色多普勒超声评估睾丸血管情况。在第二阶段及随访中均未出现睾丸萎缩。随访时所有睾丸均位于阴囊内，大小良好。未出现与腹腔镜检查相关的并发症。
对于高位腹腔内睾丸病例，分期福勒 - 斯蒂芬手术应是首选手术方法。该手术成功率高。用双极电凝进行血管离断是一种非常安全、经济有效的方法。
