Laparoscopic Management Of Muataz A. Al Ani , Bassam Kh. Al Abassy Impalpable Testes In Pediatric Age Group Muataz A. Al Ani , Bassam Kh. Al Abassy Pediatric Surgeons

Introduction Cryptorchidism is a common finding in pediatric practice ,

21% of preterm male infant. 1.8-4 % of full term boys. 0.8% of 1 year old boys. The proportion of impalpable testis has been reported up to 20% of all cryptorchied boys.

A variety of imaging modalities have been used to detect the impalpable testis, Ultrasound, Computed tomography, Magnetic resonance imaging, Arterography and venography. Non are as sensitive as laparoscopy for accurate localization of the intra abdominal testes.

Cortesi et al first reported the use of laparoscopy in the surgical management of impalpable testes in 1976. Initially, laparoscopy was used only for localization before open surgical exploration. It is only recently that laparoscopy been deemed a means of both diagnosis and treatment.

Aim Of The Study The purposes of our study was: To evaluate the role of laparoscopy in localizing impalpable testes. The management strategy for both unilateral and bilateral impalpable testes .

Patients And Methods Throughout the period between January 2005 to December 2008 , A 36 patients with impalpable testes were admitted to the pediatric surgery centre at Al khansa teaching hospital in Mosul /Iraq , Laparoscopy done for them to assess and manage 42 impalpable testes.

Ports 5-10 mm supra-umbilica port for 0ºtelescope For diagnostic laparoscopy: at least an additional port is needed. For therapeutic management: additional 2 working ports in the flanks.

Result And Discussion Intra Canalicular Testes Intra abdominal testes are classified according to the laparoscopic findings Intra Canalicular Testes

Intra Abdominal Testis Are Classified According To The Laparoscopic Findings

Intra Abdominal Testis Are Classified According To The Laparoscopic Findings vanished testes

Teratoma

Persistent Miillerian Duct Structures

A viable intra-abdominal testis The limiting factor to relocate the intra-abdominal testis to the scrotum is the length of the gonadal vessels. Assisted laparoscopic orchiopexy. Single stage Fowler-Stephen technique. Two stage Fowler-Stephen technique.

Result And Discussion 36 PATIENTS (42 IMPALPABLE TESTES) 27 Testes Were Positive 15 Testes Absents Vanished Testes 12 Vas And Vessel Enter The Internal Ring 3 With No Vas And Vessel Entering The Ring (Agenesis).

27 Testes Positive 16 Near The Internal Inguinal Ring 2 Testes Intra Canaliculare 9 In The Iliac Fosse Assisted laparoscopic orchiopexy Single stage Fowler-Stephen technique in 4 testes Two stages Fowler-Stephen technique in 2 testes Biopsy In 3 testes

Assisted Laparoscopic Orchiopexy Condition Of The Testis We followed our patients for about two years by assessing the size of the fixed testis in comparism to the other one and in relation to patient age. % F. S Procedure Assisted Laparoscopic Orchiopexy Condition Of The Testis 75 5 13 Good size 21.8 1 one stage 4 Small size 4.2 1 Atrophy 100 6 18 Total

Conclusion laparoscopy has a safe, reliable and accurate role in management of impalpable testis . It also direct the surgeon to chose the proper technique for orchiopexy . One stage assisted laparoscopic orchiopexy. Single stage Fowler Stephen laparoscopic orchiopexy . Two stages Fowler Stephen laparoscopic orchiopexy.

Thank you