Orchiopexy-laparoscopy or traditional surgical technique in patients with an undescended palpable testicle.

OBJECTIVE

To compare orchiopexy by laparoscopy versus traditional surgical technique in patients with an undescended palpable testicle in the inguinal canal.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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.