Laparoscopic orchiopexy: Is closure of the internal ring necessary?

Abstract

Narrowing of the internal ring around the pulled through spermatic cord in cases of laparoscopic orchiopexy is the norm.

To carry out a prospective study to see if closure of the internal ring is really necessary, hypothesis being that mobilization of the impalpable testis leaves a raw surface, which, coupled with the presence of the spermatic cord results in effective closure of the internal ring.

51 patients with 65 impalpable testes underwent laparoscopic orchiopexy between July 1998 and June 2003. An impalpable testis was present in 21 cases on the left, 16 cases on the right and bilateral in 14 cases. Following complete mobilization required for orchiopexy, all testes with adequate length of spermatic cord were pulled down into the scrotum through the inguinal canal. No suture was applied to narrow the internal ring around the pulled through spermatic cord. Five testes were pulled down by an opening in the medial end of the inguinal canal due to inadequate length of the spermatic cord. In these cases the internal ring was closed by a suture.

Follow up of all cases ranged between 1.5 years to 6.5 years. Not a single case has reported with recurrence of a hernia.

The results suggest that narrowing of the internal ring around the pulled through spermatic cord may not be necessary.