Flank position laparoscopic orchiopexy with colon medialization versus conventional laparoscopic orchiopexy for intra-abdominal testis: A randomized controlled trial

Abstract

Introduction and objective: The surgical management of intra-abdominal testis (IAT) remains a topic of debate. The primary challenges in different orchiopexy methods are short testicular vessels and peritoneal adhesions of IATs. This study aims to evaluate flank position laparoscopic orchiopexy (FPLO) with colon medialization as a novel surgical method for managing IATs, in comparison with the conventional supine position laparoscopic orchiopexy (SPLO).

Patients and methods: This study was a single-blind randomized parallel clinical trial. The inclusion criteria were non-palpable testes assigned to the laparoscopic approach and peeping testes requiring orchiopexy. Exclusion criteria were patients above the age of 15 years, bilateral IAT, palpable testes in the inguinal canal and scrotum, blind end vessel or vanished testis. FPLO was performed with the patient in the flank position, involving either segmental or complete release of the mesocolon attachment from the testis. The conventional method (SPLO) involved positioning the patient in the supine position and preserving testicular vasculature without additional release of the mesocolon attachment. The primary outcomes, the final position of the testis and atrophy rates, were compared between the two groups. The secondary outcomes, including surgery time, length of hospital stay, and complication rates, were also evaluated.

Result: Fifty-two pediatric patients with unilateral IAT were allocated into two groups: FPLO (n = 26) and SPLO (n = 26). There were no significant differences between the FPLO and SPLO groups regarding age, prematurity, and distance of the testis from the ipsilateral internal ring. The overall success rate, defined as the final position of the testis in the scrotum at 12 months, was 96.2 % for FPLO and 73.1 % for SPLO (relative risk: 1.32, 95 % CI: 1.03-1.68, p = 0.05). No atrophy or complications were seen in either group. In logistic regression, FPLO resulted in significantly better bottom positioning of the testis in the scrotum compared to SPLO (OR: 5.91, 95 % CI: 1.51-23.06, p = 0.011), independent of the initial distance of the testis to the internal ring and the patient's age. In subgroup analysis, patients in the FPLO method requiring segmental colon medialization had significantly lower age, shorter initial testis-ipsilateral internal ring distance, shorter surgery duration, and higher bottom positioning rates than those who underwent complete colon medialization.

Conclusion: FPLO demonstrates promising results in positioning the testis within the scrotum, particularly achieving optimal bottom positioning compared to the conventional SPLO method. Further studies with larger sample sizes are required to compare FPLO with other orchiopexy techniques for managing IATs.

Trial registration: This study was registered in the Iranian Registry of Clinical Trials (IRCT20200905048625N2).

Keywords: Cryptorchidism; Laparoscopy; Orchiopexy; Undescended testis.