Üçüncü basamak bir çocuk cerrahisi merkezinde çocuklarda palpe edilemeyen testislerin laparoskopik tedavisinin klinik sonuçları

Year 2021, Volume: 5 Issue: 3, 294 - 300, 31.12.2021

Şeref Selçuk Kılıç , Onder Ozden , Selcan Türker Çolak , Kamuran Tutuş , Murat Alkan , Recep Tuncer

https://doi.org/10.30565/medalanya.959384

Cited By: 1

Abstract

Amaç: Palpe edilemeyen testis, erkek bir hastada testisin inguinal kanal ve skrotum içerisinde bulunmaması şeklinde tanımlanır. Hastada infertilite ve testiste malign transformasyon gelişim riskini engellemek için palpe edilemeyen testisin yerleşimi ve durumunun tanımlanması önemlidir. Amacımız, palpe edilemeyen testis tanılı çocuk hastalarda tedavide uyguladığımız laparoskopik yaklaşımın sonuçlarını değerlendirmekti.

Yöntemler: Üçüncü basamak bir çocuk cerrahisi merkezinde palpe edilemeyen testis tanısı konulmuş ve laparoskopik yaklaşım ile tedavi edilmiş hastalar geriye dönük olarak incelendi. Hastaların özelliklerine göre tedavi protokolünde, laparoskopik abdominal eksplorasyon, iki aşamalı Fowler-Stephens laparoskopik orşiopeksi, primer laparoskopik orşiopeksi ve inguinal eksplorasyon uygulandı.

Bulgular: Kırk beş çocuk hastadaki 54 testise ait veriler incelendi. Vakaların %46.2’sinde intra abdominal yerleşimli saptanan testislerin %88’i internal inguinal ring girişinde yerleşimliydi. Laparoskopik abdominal eksplorasyondan sonra testislerin 7 (%28)’sine iki aşamalı Fowler-Stephens, 18 (%72)’ine primer laparoskopik orşiopeksi uygulandı. Testis bulunamayan 27 (%50) vakaya inguinal eksplorasyon uygulandı. Skrotuma indirilen 23 testisin 17 (%73.9)’si normal iken, 6 (%26)’sında atrofi gelişti. Eksize edilen 27 inguinal nubbinde testis ait canlı hücreler saptanmadı.

Sonuç: Palpe edilemeyen testisin tanı konulması ve tedavisinde laparaskopi güvenilir ve etkili bir yöntemdir. Abdomen içi testislerin yerleşim yeri, öncelikli cerrahi yaklaşım olarak inguinal eksplorasyonun düşünülmesini destekleyebilir.  

Keywords

testis, inmemiş testis, laparoskopi, orşiopeksi, pediatri

Clinical outcomes of laparoscopic treatment of non-palpable testis in children at a tertiary pediatric surgery center

Abstract

Aim: Non-palpable testis is defined as the absence of the testis in the inguinal canal and scrotum in a male patient. It is important to define the condition and location of the non-palpable testis, to prevent the risks of infertility and malignant transformation of the testis in patients. We aimed to evaluate the results of the laparoscopic approach we applied in the treatment of pediatric patients with non-palpable testes.

Methods: Patients with non-palpable testes, diagnosed and treated by the laparoscopic approach in a tertiary pediatric surgery center, were evaluated retrospectively. In the treatment protocol, laparoscopic abdominal exploration, two-stage Fowler-Stephens laparoscopic orchiopexy, primary laparoscopic orchiopexy and inguinal exploration surgical approaches were applied according to the case characteristics.

Results: Data from 54 testes in 45 pediatric patients were evaluated. Intra-abdominal testis was detected in 46.2% of the cases, with 88% of them at the entrance of the internal inguinal ring. After laparoscopic abdominal exploration, two-stage Fowler-Stephens in 7 (28%), primary laparoscopic orchiopexy in 18 (72%) were applied of testes. Inguinal exploration was performed in 27 (50%) whom no testis could not found. Seventeen (73.9%) of 23 testes that were descended into the scrotum remained viable, while atrophy occurred in 6 (26%) of them. Viable testis cells were not detected in the histopathology of 27 excised nubbins.

Conclusion: The laparoscopic approach is a reliable and effective method in the diagnosis and treatment of non-palpable testis. Localization of intra-abdominal testes may support consideration of the inguinal exploration approach as the primary surgical intervention.

Keywords

testis, undescended testis, laparoscopy, orchiopexy, pediatric

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