Incidence and concurrent laparoscopic repair of intra-abdominal testis and contralateral patent processus vaginalis.

OBJECTIVES: Laparoscopic orchiopexy is commonly practiced for the intra-abdominal testis. To a lesser extent, laparoscopy has offered an alternative approach to the inguinal hernia in children. We sought to determine the incidence of contralateral hernias in children with an intra-abdominal testis and to evaluate the efficacy and safety of performing concurrent laparoscopic orchiopexy and herniorrhaphy.

METHODS: We reviewed a single-surgeon experience with laparoscopic orchiopexy from 2001 to 2007. Boys were included in this report if they had had a concurrent open contralateral internal inguinal ring. The laparoscopic approach was used to repair the open ring and to perform the orchiopexy. Follow-up consisted of physical examinations for > or = 4 months postoperatively.

RESULTS: A total of 64 boys (aged 8 months to 4 years) underwent laparoscopic orchiopexy for nonpalpable testes. Of these 64 boys, 7 (9.1%) had an intra-abdominal testis and a contralateral patent processus vaginalis (4 left, 3 right). Evidence of air was seen within the processus vaginalis in 5 of the 7 patients. The internal ring was closed laparoscopically concurrent with the laparoscopic orchiopexy in all 7 boys. No postoperative complications had developed after a minimal follow-up of 4 months. All cases were performed on an outpatient basis, except for 1 boy with Prader-Willi syndrome for whom it was decided preoperatively to have him stay overnight for respiratory observation.

CONCLUSIONS: Routine inspection of the contralateral internal ring should be performed during laparoscopic orchiopexy. The incidence of an open ring in our study was about 9%. The concurrent laparoscopic repair of the hernia is not technically challenging and can be performed safely and successfully.