The value of 2-step laparoscopic Fowler-Stephens orchiopexy for intra-abdominal testes.

PURPOSE

We report our experience in the treatment of high intra-abdominal testis with a complete laparoscopic 2-stage Fowler-Stephens procedure with associated transperitoneal closure of the internal ring in pediatric patients.

MATERIALS AND METHODS

Between 1990 and 1997, 100 boys with 105 nonpalpable testes underwent laparoscopy. Laparoscopy showed intra-abdominal testis in 40 cases. In 5 cases when the testis was just proximal to the internal ring, we performed standard orchiopexy. In 35 cases with the testis in the high intra-abdominal position, we performed the Fowler-Stephens procedure with the first stage performed laparoscopically. To date, all 35 testis have undergone the second phase after 6 to 12 months (2 by open technique, 33 by laparoscopy). The last 33 patients underwent the second phase of the 2-stage Fowler-Stephens procedure by laparoscopy with associated video surgical transperitoneal closure of internal ring.

RESULTS

All testes were successfully placed in the scrotum. At a mean 30 months of followup, with clinical examination, ultrasonography and comparative colorimetric echo Doppler study, all testes were viable in the scrotum, except for 1 that became atrophic 2 months after the second open phase of 2-stage Fowler-Stephens technique.

CONCLUSIONS

Our early results suggest that the 2-stage Fowler-Stephens procedure, performed completely using laparoscopy, is a feasible technique for treating high intra-abdominal testis.