Anand Sachit, Singh Apoorv, Bajpai Minu
Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India.
Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India.
J Pediatr Urol. 2021 Apr;17(2):183-189. doi: 10.1016/j.jpurol.2020.12.012. Epub 2020 Dec 19.
Orchiopexy for cryptorchidism is one of the common day-care surgeries performed by pediatric surgeons across the globe. Although majority of the surgeons reposition the testis into a sub-dartos pouch, the practice of taking an additional transparenchymal anchoring suture is often debated. The potential risks include impaired spermatogenesis and sub-fertility. Also, a consensus statement regarding the superiority of suture fixation over no suture fixation, in terms of prevention of recurrence of cryptorchidism, is lacking. This systematic review and meta-analysis aims to compare the outcomes of orchiopexy between the two groups i.e. without (Group A) and with the transparenchymal suture fixation (Group B).
The authors systematically searched the databases PubMed, EMBASE, Web of Science and Scopus through October, 2020 for comparative studies. Statistical analysis was performed using a fixed-effects model; and pooled risk ratio (RR) and heterogeneity (I) were calculated. The methodological quality of the studies was assessed utilizing the Downs and Black scale.
Five comparative studies, comprising a total of 734 and 1002 children within the groups A and B respectively, were recruited in this study. As compared to the children belonging to group A, a significantly higher incidence of recurrence of cryptorchidism (RR 1.75; 95% CI 1.10-2.80, p = 0.02) was observed among the children of group B. However, the difference in the incidence of testicular atrophy could not reach statistical significance (RR 1.56; 95% CI 0.23-10.50, p = 0.65). The average Downs and Black scale scores ranged from 15 to 21.5, with all the studies having moderate to high-risk of bias.
The present meta-analysis revealed superiority of orchiopexy performed without transparenchymal suture fixation in terms of recurrence of cryptorchidism. Although, the incidence of testicular atrophy was higher among the children belonging to the suture group, no statistically significant difference was observed among the two groups. However, the level of evidence of the published comparative studies is limited. Therefore, it is recommended to focus on adequate mobilization of the testis and its positioning in the sub-dartos with minimal tension rather than over-reliance on futile adjuncts like taking transparenchymal testicular suture.
隐睾症的睾丸固定术是全球儿科外科医生进行的常见日间手术之一。尽管大多数外科医生将睾丸重新定位到肉膜下袋中，但额外进行实质内锚定缝合的做法常常存在争议。潜在风险包括精子发生受损和生育力低下。此外，在预防隐睾症复发方面，关于缝合固定优于不进行缝合固定的共识声明也很缺乏。本系统评价和荟萃分析旨在比较两组睾丸固定术的结果，即不进行（A组）和进行实质内缝合固定（B组）。
作者通过2020年10月前系统检索了PubMed、EMBASE、Web of Science和Scopus数据库以查找比较研究。采用固定效应模型进行统计分析；计算合并风险比（RR）和异质性（I）。利用唐斯和布莱克量表评估研究的方法学质量。
本研究纳入了5项比较研究，A组和B组分别共有734名和1002名儿童。与A组儿童相比，B组儿童隐睾症复发的发生率显著更高（RR 1.75；95% CI 1.10 - 2.80，p = 0.02）。然而，睾丸萎缩发生率的差异未达到统计学意义（RR 1.56；95% CI 0.23 - 10.50，p = 0.65）。唐斯和布莱克量表的平均得分在15至21.5之间，所有研究都有中度到高度的偏倚风险。
本荟萃分析显示，在隐睾症复发方面，不进行实质内缝合固定的睾丸固定术具有优势。虽然缝合组儿童的睾丸萎缩发生率较高，但两组之间未观察到统计学上的显著差异。然而，已发表的比较研究的证据水平有限。因此，建议重点在于充分游离睾丸并将其以最小张力置于肉膜下，而不是过度依赖如进行实质内睾丸缝合等无用的辅助手段。
