Escarcega-Fujigaki Pastor, Rezk Guillermo Hernandez-Peredo, Huerta-Murrieta Edgar, Lezama-Ramirez Nancy, Hernandez-Gomez Santiago, Kuri-Cortes Gerardo, Bañuelos-Montano Abimael
Department of Pediatric & Pediatric Surgery, Centro de Especialidades Médicas del Estado de Veracruz, Dr. Rafael Lucio, Xalapa, Veracruz, México.
J Laparoendosc Adv Surg Tech A. 2011 Mar;21(2):185-7. doi: 10.1089/lap.2010.0145.
To compare orchiopexy by laparoscopy versus traditional surgical technique in patients with an undescended palpable testicle in the inguinal canal.
A prospective, comparative, observational, longitudinal, and double-blind research was done between August 2006 and March 2009 in the Centro de Especialidades Médicas del Estado de Veracruz, "Dr. Rafael Lucio"; 63 patients underwent surgery, age 1-10 years, all with the diagnosis of palpable undescended testicle in the inguinal canal; in 33 patients, the traditional surgical technique and in 30 patients laparoscopy were done. A visual analogue scale (VAS) was used to evaluate post-surgery pain. A testicle ultrasound was practiced before surgery and at 6 months after it.
The majority of patients were 1-4 years old with a median age of 2.3 years; 51 cases were unilateral and 12 cases were bilateral; 37 testicles were descended with the open traditional surgical technique and 38 through laparoscopy (75 testicles); 44 on the right side and 31 on the left side; there was a hernia associated with 37 undescended testicles, 23 with open surgical technique, and 14 by laparoscopy, without relapsing in any patient. The median surgery time with the open surgical technique was 38 minutes and by laparoscopy, it was 45 minutes. The gobernaculum testis was sectioned by laparoscopy in 23 descended testicles to facilitate the procedure, in the remaining 11 it was not necessary; whereas in the open technique, all the gobernaculum testis were sectioned. In 80% of cases, the laparoscopy caused less pain when compared with the other technique. All patients regardless of the technique used left hospital during the first 24 hours. All have had follow-up for more than 6 months with a median of 18 months, with satisfactory results in relation to size and location of the testicle, with a good ultrasound correlation, and not finding any statistical differences between surgical techniques. There were no accidents with any of the techniques, and 1 patient with the open technique had an important hematoma; hemophilia was later diagnosed in the patient. The esthetical aspect was better with laparoscopy, but the cost was 15% more expensive with the open technique.
Both techniques had satisfactory results without any significant differences to make us choose one over the other. It is the surgeons' decision based on experience and training on laparoscopy to choose any of the techniques.
比较腹腔镜下睾丸固定术与传统手术技术治疗腹股沟管内可触及的隐睾患者的效果。
2006年8月至2009年3月在韦拉克鲁斯州“拉斐尔·卢西奥博士”医学专科中心进行了一项前瞻性、对比性、观察性、纵向和双盲研究；63例年龄1至10岁的患者接受了手术，均诊断为腹股沟管内可触及的隐睾；33例患者采用传统手术技术，30例患者采用腹腔镜手术。使用视觉模拟量表（VAS）评估术后疼痛。术前及术后6个月进行睾丸超声检查。
大多数患者年龄在1至4岁，中位年龄为2.3岁；51例为单侧，12例为双侧；37个睾丸通过开放传统手术技术下降，38个通过腹腔镜下降（共75个睾丸）；右侧44个，左侧31个；37个隐睾伴有疝气，开放手术技术组23例，腹腔镜组14例，所有患者均未复发。开放手术技术的中位手术时间为38分钟，腹腔镜手术为45分钟。23个下降的睾丸通过腹腔镜切断睾丸引带以方便手术，其余11个则无需切断；而在开放技术中，所有睾丸引带均被切断。80%的病例中，腹腔镜手术引起的疼痛比另一种技术少。所有患者无论采用何种技术均在术后24小时内出院。所有患者均随访超过6个月，中位随访时间为18个月，睾丸大小和位置的结果令人满意，超声相关性良好，两种手术技术之间未发现任何统计学差异。两种技术均未发生意外，1例采用开放技术的患者出现重要血肿；后来诊断该患者患有血友病。腹腔镜手术的美学效果更好，但开放技术的费用贵15%。
两种技术均取得了满意的效果，没有显著差异使我们偏向选择其中一种。外科医生应根据腹腔镜手术的经验和培训来决定选择哪种技术。
