Borkar Nitinkumar Bhajandas, Tiwari Charu, Mohanty Debajyoti, Vepakomma Deepti, Nagdeve Nilesh
Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India.
Department of General Surgery, AIIMS, Raipur, Chhattisgarh, India.
Urol Ann. 2024 Jan-Mar;16(1):64-70. doi: 10.4103/ua.ua_11_23. Epub 2023 Nov 15.
Laparoscopic exploration is currently considered the gold standard for managing nonpalpable intraabdominal testes. The problem of short vascular pedicle is addressed in Fowler-Stephen (FS) technique by the division of testicular vessels and in Shehata technique (ST) by traction on testicular vessels. There is a lack of the consensus among pediatric surgeons on the choice of one technique over other. This analysis compares the reported outcomes of staged laparoscopic orchidopexy by ST with the time tested FS technique in managing high intraabdominal undescended testis.
The present systematic review and meta-analysis was conducted as per the preferred reporting items for the systematic review and meta-analyses guidelines. Only randomized controlled trials and comparative studies were included. The primary outcomes compared were the incidence of testicular atrophy, testicular retraction/ascent rate, and operative time of Stage I and Stage II orchidopexy.
The present analysis was based on three randomized studies with a total of 119 undescended testes in 117 patients satisfying the inclusion criteria. The operative time was less in Stage I FS technique; however, there was no statistically significant difference in operative time of both procedures during the Stage II laparoscopic orchidopexy. Pooled analysis of postintervention testicular atrophy, testicular retraction rate, and duration of postoperative hospitalization showed no difference between both procedures.
Both FS and STs are comparable in terms of postintervention testicular atrophy, testicular retraction/ascent; however, the mean operative time is significantly less with FS technique in Stage I laparoscopic orchidopexy.
目前，腹腔镜探查被认为是处理不可触及的腹腔内睾丸的金标准。福勒 - 斯蒂芬（FS）技术通过切断睾丸血管来解决血管蒂短的问题，而谢哈塔技术（ST）则通过牵拉睾丸血管来解决。小儿外科医生在选择一种技术而非另一种技术上缺乏共识。本分析比较了ST分期腹腔镜睾丸固定术与经过时间考验的FS技术在处理高位腹腔内隐睾方面的报告结果。
本系统评价和荟萃分析按照系统评价和荟萃分析指南的首选报告项目进行。仅纳入随机对照试验和比较研究。比较的主要结局是睾丸萎缩的发生率、睾丸回缩/上升率以及I期和II期睾丸固定术的手术时间。
本分析基于三项随机研究，共117例患者中的119个隐睾符合纳入标准。I期FS技术的手术时间较短；然而，在II期腹腔镜睾丸固定术中，两种手术的手术时间在统计学上无显著差异。干预后睾丸萎缩、睾丸回缩率和术后住院时间的汇总分析显示两种手术之间无差异。
在干预后睾丸萎缩、睾丸回缩/上升方面，FS和ST两种技术具有可比性；然而，在I期腹腔镜睾丸固定术中，FS技术的平均手术时间明显更短。
