Pediatric Surgery Unit, Azienda Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
Hernia. 2014 Jun;18(3):339-42. doi: 10.1007/s10029-013-1114-7. Epub 2013 May 24.
To report our experience using a modified orchidopexy with division and non-ligation of the processus vaginalis.
We performed a single-centre retrospective analysis of all patients who underwent orchidopexy between December 2005 and October 2008 at our institution. In the present technique, the processus vaginalis was gently peeled off the spermatic cord structures as high as possible and severed at the level of the internal inguinal ring without its ligation. Postoperative follow-up was routinely offered to all patients. Additionally, we made a special clinical follow-up, ranging from 1 to 69 months (median 34).
One hundred and twenty-three patients, aged 1-11 years (median 3), underwent 147 orchidopexies during the study period. Of these, 25 were accomplished using conventional division and ligation of the processus vaginalis, and in the remaining 122 orchidopexies, the processus vaginalis was only divided. Of the 137 testes available at follow-up, 134 were in the scrotum and 3 (2 %) required re-do orchidopexy due to secondary reascent, including 2 treated with division only of the processus vaginalis. None of the patients experienced postoperative hydrocele or inguinal hernia development.
Our findings confirm that division without ligation of a patent processus vaginalis is usually followed by spontaneous peritoneal scarring and complete closure of the internal inguinal ring. Present technique is as effective as traditional orchidopexy and saves extra time spent for meticulous closure of the processus vaginalis or peritoneal tears.
报告我们使用改良的精索固定术，同时对鞘状突进行分离但不结扎的经验。
我们对 2005 年 12 月至 2008 年 10 月在我院接受精索固定术的所有患者进行了单中心回顾性分析。在目前的技术中，将鞘状突从精索结构上轻轻剥离，尽可能高，并在腹股沟内环水平处切断，而不结扎。所有患者均常规接受术后随访。此外，我们进行了特殊的临床随访，随访时间为 1 至 69 个月（中位数 34 个月）。
123 例年龄 1-11 岁（中位数 3 岁）的患者在研究期间接受了 147 次精索固定术。其中 25 例采用传统的鞘状突分离和结扎术完成，其余 122 例仅行鞘状突分离。在可随访的 137 个睾丸中，134 个位于阴囊内，3 个（2%）因二次上升需要再次进行精索固定术，其中 2 例仅行鞘状突分离。无患者发生术后鞘膜积液或腹股沟疝。
我们的发现证实，未结扎开放的鞘状突通常会导致自发性腹膜瘢痕形成和完全闭合内环。目前的技术与传统的精索固定术同样有效，并节省了仔细缝合鞘状突或腹膜撕裂的额外时间。
