P1.082: Outcomes of Laparoscopic Orchiopexy for Intrabdominal Testis: A Single Institutional Experience

Background: Intrabdominal undescended testes (IAT) with short spermatic vessels create a dilemma. Orchiopexy requires dividing the testicular vessels and either bringing the testis down at the same time or returning several months later. The auspice of the latter is to allow for the collateral blood supply to the testis to improve during the interval to reduce the risk of testicular atrophy. However, in a small pilot trial, we previously found no difference in atrophy between the two approaches. The aim of the present study is to compare the results between single and 2 stage orchiopexy in a large single center cohort where both are performed.

Methods: A single institution retrospective study from January, 2012 to December, 2023 was conducted. We included patients ≤ 10 years old who underwent laparoscopic orchiopexy for IAT. We included patients who underwent direct orchiopexy without division of the vessels (DO) as a baseline comparison for those who underwent either single stage (SSO) or 2 stage (2SO) orchiopexy with vessel division. Primary outcome of interest was atrophy rate. Secondary outcomes were correct position into the scrotum and any post-operative complications. Differences between groups were compared by using Fisher’s Exact tests and Mann Whitney U tests for categorical and continuous variables respectively.

Results: A total of 259 patients underwent surgery for IAT during the study period (Figure 1): 216 with unilateral and 43 with bilateral IAT, for a total of 302 testicles. Four testicles were found atrophic at laparoscopic exploration and were excluded. Of the 298 testes that underwent orchiopexy, 112 (37.6%) were DO, 98 (32.9%) were SSO and 88 (29.5%) were 2SO. Demographics and perioperative characteristics are described in Table 1. Outcomes at follow-up were available for 259 (85.8%) testicles with median follow-up of 6.4 [interquartile range 1.7-8.9] months. Atrophy occurred in 6 (6.2%) of testicles managed with DO, 17 (19.5%) with SSO and 8 (10.7%) with 2SO (p=0.019). When comparing SSO vs 2SO, although SSO group had a higher rate of atrophy, this difference was not statistically significant (p=0.132). A subgroup analysis including cases in which the gubernaculum was preserved demonstrated no differences between single and two-stage [SSO: 4 (12.1%) and 2SO: 6 (12.2%); p=1.0]. Finally, postoperative complications occurred in 4 patients: there were 2 ascent testicles in the 2SO group requiring redo orchiopexy, one inguinal hernia repair and one umbilical hernia repair, both of which were in the DO group.

Conclusion: When an orchiopexy requires division of the vessels, the single stage approach is associated with a potentially higher rate of atrophy. However, when gubernaculum is preserved, there are no differences between single and 2 stage orchiopexy. We believe a single stage orchiopexy with gubernacular preservation should be considered when the vessels need to be divided.