Comparison of inguinal exploration with laparoscopic exploration in nonpalpable undescended testis with cord-like structure on palpation

Abstract

In patients where the testis cannot be palpated within the scrotum or at any point in the inguinal canal, surgeons typically begin with laparoscopic exploration to assess the abdomen. If no intra-abdominal testis is found during laparoscopy and the entry of cord elements into the inguinal canal through the internal ring is observed, laparoscopy is concluded, and open surgery with inguinal exploration is performed. To avoid the economic burden and potential complications associated with simultaneous laparoscopic and open surgery, we aim to evaluate direct open surgery in patients with non-palpable undescended testis (UDT) who have a palpable cord-like structure during examination. Methods: In this controlled clinical trial, 40 pediatric and infant patients with a diagnosis of non-palpable undescended testis (NPUDT) and a palpable cord-like structure on examination, who were admitted to Zahra Mardani Azari Hospital within the next six months, were included in the study. Patients were randomly divided into two groups: one undergoing open inguinal exploration and the other laparoscopic surgery. Data, including age, sex, comorbidities, ultrasound findings, type of surgery, and outcomes, were collected. In the first group, open exploration of the inguinal area was performed from the outset. If cord elements were observed passing through the internal ring into the inguinal canal, the surgery proceeded in the same manner and concluded after anatomical correction. In the second group, laparoscopic exploration of the abdominal area was initially conducted. If the cord elements were seen passing through the internal ring into the canal, laparoscopy was stopped, and open surgery was performed for correction. Results:In the diagnostic method of Blind-ending vas deferens vessels, 15% of patients in the laparoscopic group and 5% in the inguinal exploration group were diagnosed on the right side, and 25% and 30% on the left side, respectively (P=0.744 and P=0.774). For the diagnosis of atrophic testes, 5% of patients in the laparoscopic group and 20% in the inguinal exploration group on the right side (P=0.226) and 30% and 25% on the left side were diagnosed. Regarding the duration of surgery, the mean surgery time in the laparoscopic group was significantly longer than in the open surgery group (P=0.001), likely due to the need to perform both laparoscopic and open surgeries in all cases. It is noteworthy that none of the cases in the laparoscopic surgery group required two-stage orchiopexy.