Inguinal re-operation after an unsuccessful primary orchiopexy: Approach through internal oblique muscle incision

Abstract

Objective: We aimed to present our experiences with inguinal re-operations and resulting long term outcomes in cryptorchidism cases who had previously underwent unsatisfactory orchiopexy procedures where proper testis position had not been achieved. Materials and Methods: Between January 2000 and May 2014, twenty eight patients with abnormal testis position (bilateral in one) were evaluated. All patients had a history of previous inguinal operation. Results: The mean age at re-operation time was 12±5.7 years(2-27). A successful orchiopexy was performed in 19 testes of 18 patients. Internal oblique muscle incision was performed in order to provide adequate mobilization so that the spermatic vessels and vas deferens would not be too tight in 10 of the 19 testes(52.6%). During re-orchiopexy, a patent processus vaginalis was deteced in 6 cases(31.5%) and unsuccessful hernia repair was detected in 3 cases (15.7%). Orchiectomy was performed for 10 testes either due to testicular atrophy or the presence of a short spermatic cord. Conclusion: İn inguinal re-operatıon after an unsuccessful primary orchiopexy, the success rate of surgery may be improved in the hands of experienced pediatric surgeons where better visualisation of the internal inguinal ring is achieved with internal abdominal muscle incision which provides a proper dissection and a sufficient lenght of cord and spermatic vessel.

Keywords

• Cryptorchidism,İnguinal canal,Reoperation

Başarısız primer orşiopeksiden sonra inguinal reoperasyon: İnternal oblik kas inzsizyonu yoluyla yaklaşım

Abstract

Amaç: Geçmişte orşiopeksiye maruz kalmış ancak testis pozisyonu tatmin edici olmayan inmemiş testisli olgularda, uyguladığımız inguinal reoperasyon deneyimlerimizi ve uzun dönem sonuçlarını sunmayı amaçladık. Gereç ve Yöntem: Ocak 2000- Mayıs 2014 tarihleri arasında 29 anormal testis pozisyonlu(1 bilateral) 28 hasta değerlendirildi. Bütün hastaların geçmişte inguinal cerrahi hikayesi mevcuttu. Uzun dönem takipte prepubertal hastalarda sadece klinik muayene yapılırken postpubertal hastalara, semen analizi ve testiküler volüm muayenesi de yapıldı. Bulgular: Reoperasyon uygulanan 28 hastanın reoperasyon zamanında ortalama yaşları 12±5.7 yıl (2-27) idi. Toplam 18 hastada 19 testise başarılı reorşiopeksi uygulandı. Reorşiopeksi uygulanan 19 hastanın preoperatif testis lokalizasyonu sırasıyla internal inguinal ring, inguinal kanal, eksternal inguinal ring; 2,13,4 idi. 19 testisin 10’unda (%52.6) spermatik damarlar ve vas deferensin gergin olmayacak şekilde yeterli mobilizasyonunu sağlamak için internal oblik kas kesisi yapıldı. Reorşiopeksi esnasında vakaların 6’sında (%31.5) patent processus vajinalis, 3’ünde ise (%15.7) başarısız herni onarımı belirlendi. 10 testise ise atrofik testis veya spermatik kord kısalığından dolayı orşiektomi uygulandı. Reorşiopeksi yapılan 19 hastanın 11’i (%57.8) uzun dönem takip için başvurdu. Ortalama takip süresi 37.4±27.9 ay (4-95) idi. Tüm testisler atrofi olmaksızın skrotum içinde idi. Sonuç: Başarısız primer orşiopeksiden sonra inguinal reoperasyonlarda, deneyimli pediatrik cerrahlar tarafından uygun diseksiyonla internal abdominal kas kesisi yapılarak, daha iyi internal inguinal ring vizüalizasyonu sağlanıp, yeterli kord ve spermatik damar uzunluğu elde edilerek operasyonun başarı oranları anlamlı şekilde artırılabilir

Keywords

• Kriptorşidizm,İnguinal kanal,Reoperasyon

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