Laparoscopic two-stage Fowler-Stephens orchiopexy via Hesselbach’s triangle for the intra-abdominal testes in pediatric patients

Abstract

Abstract Purpose To validate the feasibility and advantages of laparoscopic two-stage Fowler-Stephens (F-S) orchiopexy for managing intra-abdominal testes via Hesselbach's triangle in pediatric patients.Materials and Methods Retrospective analysis was conducted on pediatric patients with impalpable cryptorchidism between June 2017 and September 2022. All cases underwent laparoscopic exploration, and those with intra-abdominal testes were included in this study. Laparoscopic Fowler-Stephens staged operation was performed on all eligible cases. The testicular gubernaculum and vas deferens blood supply during the first stage, as well as collateral circulation of vas deferens blood supply during the second stage were observed. Postoperative color ultrasound was utilized to monitor testicular volume and parenchymal echo.Results A total of 41 cases with intra-abdominal testes were included in the study. Results from the first stage of surgery indicated a positive correlation between higher testicular position and increased dysplasia of the gubernaculum. During the second stage, all vas deferens exhibited thicker blood supply compared to preoperative measurements. All testes were successfully descended into the middle scrotum without re-ascent during postoperative follow-up, and no instances of testicular atrophy or abnormal parenchymal echo were observed.Conclusions The testicular gubernaculum is less developed with the higher testicular position. Staged surgery is helpful to establish adequate collateral circulation of the vas deferens blood supply. Laparoscopic Fowler-Stephens orchiopexy through Hesselbach’s triangle approach is safe and effective,which can lower the testicle to a satisfactory position.