A prospective comparative study of open versus laparoscopic stage II Fowler-Stephens orchidopexy in pediatric patients

Abstract

Introduction: Laparoscopic Fowler Stephens orchidopexy, single stage or two-stage, is now routinely performed in non-palpable testis. We performed second stage orchidopexy as open inguinal approach and compared the outcome of this approach to two-staged laparoscopic orchidopexy.

Methods: We performed a prospective randomized interventional study of two different approaches for intra-abdominal testis. In group A, Laparoscopic stage I (SFO) followed by open inguinal orchidopexy was compared for final outcome in group B cases, who underwent laparoscopic staged SF orchidopexy. The average duration between stage I SF and stage II SF was 6 months. All the procedures were done under GA and caudal analgesia. The pre-operative and post-operative USG dimensions were compared in cm and cm³/ml. The procedure outcome was considered successful if testis remained inside scrotum below mid-scrotal point. Any testis above the mid-scrotal point was considered as unacceptable or failure of procedure.

Results: This study was performed on 74 children with 84 testis (group 'A' 38 patients (48 testis) and group 'B' 36 patients (46 testes)), with average age was 3.3 ± 0.46 and 3.9 ± 0.58 years, respectively. In group 'A', 38 patients (48 testes) underwent lap SFO I followed by inguinal orchidopexy and in group 'B', 36 patients (46 testes) underwent laparoscopic staged SF O. The mean testicular volume pre-operative in group 'A' & 'B' was 0.28 ± 0.04 and 0.23 ± 0.06 cm², respectively. The mean post-operative testicular volume was 0.34 ± 0.07 and 0.28 ± 0.05 cm², respectively. The average follow-up of the patients in group 'A' & 'B' was 24 ± 3.67 and 20 ± 2.90 months, respectively. Testis was having good volume in 87.5% and 76.60% of these successful cases, respectively. There were (3/48) 6.25% (4/46) 8.69% testicular atrophy cases in group 'A' & 'B', respectively. The differences were not statistically significant (p < 0.05). The mean operative time in group A was 20 ± 8.07 min and group B 30 ± 7.19 min in stage II procedure.

Conclusion: The success rate in group A was more than the group B which was statistically significant (p > 0.05). Our study connotes that open stage II orchidopexy is still feasible and practicable with better final outcome of management of non-palpable cases.

Keywords: Stephen Fowler orchidopexy (SFO); laparoscopy; non palpable testis.