Pediatric Urology

Cryptorchidism, Open Processus vaginalis, and Associated Hernia: Laparoscopic Approachto the Intern al Inguinal Ring
C. Radmayr, S. Corvin, M. Studen, G. Bartsch, G. Janetschek

Department of Urology, University of Innsbruck, Austria

Address of Corresponding Author

Eur Urol 1999;36:631-634 (DOI: 10.1159/000020058)

  Key Words

• Laparoscopy
• Internal inguinal ring
• Cryptorchidism
• Hernia

  Abstract

Objectives: A nonpalpable testis was the first indication for laparoscopy in urology. This primarily diagnostic procedure has evolved to complete laparoscopic orchidopexy. An associated inguinal hernia due to an open processus vaginalis is reported in 26% of cryptorchidism cases. Simultaneous laparoscopic orchidopexy and herniorrhaphy are therefore the next logical step. Methods: Between 1992 and 1998, 61 children underwent laparoscopy for pathology of the internal inguinal ring. In 48 boys the operation was performed for a nonpalpable testis and in 13 boys laparoscopic transection of the processus vaginalis was performed because of clinical hydrocele. Results: In 25 of the 48 cases an intra-abdominal location was found with 18 existing and 7 vanishing testicles. Laparoscopic orchidopexy was performed either as a two-stage Fowler-Stephens technique (n = 6) or as a direct one-stage repair (n = 12). In 6 boys with cryptorchidism a direct inguinal hernia was associated, which received simultaneous laparoscopic herniorrhaphy. In 23 cases of cryptorchidism with an inguinal location of the testis, 3 vanishing testicles were found. In 20 cases with normal testicular vessels, an inguinal exploration followed. In 4 of the hydrocele cases additional herniorrhaphy had to be performed. In all cases the operation could be performed as planned without complications. After orchidopexy all testicles were in the normal position and well perfused as revealed by flow Doppler sonography. All hydroceles disappeared within several days. There was no inguinal hernia recurrence. Conclusions: Laparoscopic dissection of the internal inguinal ring allows perfect delineation of the anatomic structures and their relationship. Transection of the processus vaginalis can be performed without disturbance of the inguinal canal. Hernias can be closed with essentially the same technique as used in open surgery. Morbidity was minimal in all patients.

Copyrightz1999S.KargerAG,Basel

  Author Contacts

Prof. Dr. Christian Radmayr
Department of Urology, University of Innsbruck
Anichstrasse 35
A-6020 Innsbruck (Austria)
Tel. +43 512 504 4810, Fax +43 512 504 4873, E-Mail christian.radmayr@uibk.ac.at

  Article Information

Accepted after revision: April 22, 1999
Number of Print Pages : 4
Number of Figures : 3, Number of Tables : 3, Number of References : 7