Diagnostic laparoscopy for contralateral patent processus vaginalis and nonpalpable testes.

Diagnostic laparoscopy can be a valuable adjunct for the surgical approach to surgical conditions in children. Two frequently employed indications for diagnostic laparoscopy in children include (1) the search for a contralateral patent processus vaginalis in a child with a known inguinal hernia and (2) localization and management in boys with a nonpalpable testis. Laparoscopy to investigate a possible contralateral patent processus vaginalis is easily performed using a 3-mm, 70 degrees telescope through the known inguinal hernia sac and requires only 5 minutes for completion. Diagnostic laparoscopy in boys with a nonpalpable testis is performed through a 5-mm cannula placed in the umbilicus and takes less than 10 minutes to accomplish. Depending on the laparoscopic findings, ligation of the testicular vessels is possible at laparoscopy in boys with an abdominal testis who appear best managed by a two-staged Fowler-Stephens operation. In addition, laparoscopic orchiectomy may be performed in teenage boys who have an atrophic testis.