Laparoscopic versus open orchidopexy in management of non palpable undescended testis; over5 year single centre experience

Introduction: About 1-2% of boys at age of 1 year have an undescended testis (UDT). Nonpalpable testis represents a diagnostic challenge and a therapeutic dilemma. Laparoscopy was first used in 1976 to locate undescended testes. Methods: This prospective comparative study was carried out in the postgraduate Department of General Surgery, Government Medical College, Srinagar from May 2010 to October 2015. 100 undescended testes were managed operatively during this period, laparoscopic (n=50) (Group A) and open (n=50) (Group B).Various parameters like, Operative time, Intra and post operative complications, Conversion to open were recorded, Post operative assessment like hospital stay and analgesia required. Patients were followed for 6 months. Results: The median age was 2.51and 2.86 years in laparoscopic and open group respectively. In the laparoscopic group 26 patients had right sided non-palpable testis, 14 had the left sided and 5 patients had bilateral abnormality. In the open group 28 had right sided undescended testis, 16 patients had left and 3 patients had bilateral abnormality. The sensitivity of ultrasonography in localizing the undescended testis was 74 % as against 100% in laparoscopy. There were two minor intraoperative complications in group A as compared to one in group B. There were nine postoperative complications in total. The complications were relatively more in the open group and added to hospital stay and morbidity significantly. Most of the patients were discharged on first postoperative day (mean hospital stay 1.3 vs. 1.8 days in group A and B respectively). Laparoscopic orchidopexy group had generally lesser use of analgesics. On long term follow up a total of 3 patients developed atrophy of operated testicle; of these 2 were from the laparoscopic group. Conclusions: laparoscopy is an extremely useful and safe modality for both the diagnosis and management of impalpable testes. However, traditional open orchiopexy is also a feasible alternative.