Laparoscopic management of undescended impalpable testis.

Chithra, Ramu (2008) Laparoscopic management of undescended impalpable testis. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION : Today we live in the era of minimally invasive surgery. The applicability, advantages and safety of laparoscopy in the field of pediatric surgery have been adequately enumerated and documented. About 10-30% of undescended testes are impalpable. Of all the available diagnostic modalities laparoscopy offers the most definitive direct visual diagnosis. In fact it is considered a diagnostic gold standard. The diagnostic detail offered is complete and provides adequate information for planning further management in the same sitting either as a single procedure or in a staged manner. In effect laparoscopy appears to be the most ideal diagnostic and therapeutic tool for the management of impalpable undescended testis in a pediatric surgeon’s armamentarium. This study is undertaken to evaluate the role of laparoscopy in management of impalpable undescended testis and to analyse the experience at our institute. We aim to evaluate the diagnostic fallacies if any, finer technical nuances of the procedure, and to assess the outcome in the short term, including the incidence and significance of post-operative complications. AIMS : 1. To study the relative incidence of impapability of undescended testis. 2. To laparoscopically document the findings of impalpable undescended testis. 3. To describe and evaluate laparoscopic surgical technical options in the treatment of impalpable undescended testis. 4. To assess short-term post-operative outcome. MATERIALS AND METHODS : Study design: This is a retrospective and prospective study analyzing the laparoscopic management - both diagnostic and therapeutic – of the undescended impalpable testis performed at Coimbatore Medical College Hospital, Coimbatore. Study period: May 2000 to April 2008. Study center: Department Of Pediatric Surgery Coimbatore Medical College Hospital Coimbatore. Study group: A total of seventy-six male children with undescended impalpable testis had presented and were managed laparoscopically at our institute during the period of study. Exclusion criteria: All patients with impalpable undescended testis with abnormal serum studies – serum electrolytes, testosterone and dihyhrotestosterone - suggestive of intersex disorders Age group – 9 months to 13 years. Type of procedures; Diagnostic laparoscopy, Single stage orchiopexy. Staged Fowler-Stephen procedure, Laparoscopic mobilization and open orchiopexy, Atrophic testis excision. CONCLUSIONS : 1. The relative incidence of testicular impalpability in UDT is 22.15%. 2. Diagnostic laparoscopy positively identifies intra-abdominal testicular location or atrophy in all cases. 3. The status of the testes that had emerged was correctly indicated in most cases. 4. Laparoscopy was an effective tool in almost 95% of cases for either diagnosis or mobilization,and would have been unnecessary in only about 5% if an ultrasonogram had been done preoperatively. 5. Laparoscopy is safe and effective and well tolerated. 6. The results of the single-staged and the staged Fowler-Stephen procedure are comparable when intra-operative findings are analyzed before decision making. 7. The delayed presentation of cases is a cause for concern. 8. Long term follow up is needed for final evaluation.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Laparoscopic management ; undescended impalpable testis.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 31 Jul 2017 04:10
Last Modified: 31 Jul 2017 04:10

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