A combined preperitoneal and inguinal approach for redo orchiopexy

Journal of Pediatric Urology
Dimitrios Sfoungaris, Vassilios Mouravas

Abstract

Redo orchiopexy involves a hazardous dissection inside the inguinal canal (IC) where scar tissue encircles the testicular vessels (TesV), vas deferens (VD), and the testis. The aim was to describe and evaluate a combined preperitoneal and inguinal approach (CPI) through a single cutaneous incision and accomplish this task as safely as possible, at the same time permitting additional maneuvers for cord lengthening. We prospectively studied eight patients aged from 2.7 to 13 years (mean 7 years) reoperated for failed orchiopexy using the CPI approach. Reoperation took place 12 months to 11 years (mean 4.4 years) after the initial operation. Through a single transverse skin crease incision over the IC, at the level of the deep inguinal ring (DIR), we gained access to both the preperitoneal space (PPS) and the IC. We first entered the PPS, the peritoneum is retracted, and the VD and TesV are seen entering the DIR. They are gently dissected and two vascular lacets are passed around them. We introduce the backside of an anatomic forceps through the DIR, just under the anterior IC wall, until it is impeded by adhesions and then incise above the forceps, thus protecting the cord structures. Through that opening we transpose one of the ...Continue Reading

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Citations

May 10, 2016·The Journal of Urology·Roberto Iglesias LopesWalid A Farhat
Jan 25, 2017·Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie·J-B MarretJ Rod
Feb 23, 2020·Arab Journal of Urology·Ahmed Abdelhaseeb YoussefTamer Yassin Mohamed Yassin

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