Publication: Stephens-Fowler en 2 tiempos: resultados 14 años después
Authors
Ruiz Pruneda, R. ; Aranda García, M.J. ; Sánchez Morote, J.M. ; Cabrejos Perotti, K. ; Girón Vallejo, Óscar ; Roqués Serradilla, J.L. ; Trujillo Ascanio, A. ; Bueno Ruiz, J.F. ; Ruiz Jiménez, J.I.
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Facultad de Medicina
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Publisher
Sociedad Española de Cirugía Pediátrica
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DOI
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info:eu-repo/semantics/article
Description
El trabajo ha sido presentado en el Congreso Nacional de Cirugía Pediátrica. La Gomera 2010
Abstract
El manejo del testículo intraabdominal puede ser difícil, como lo demuestran las múltiples modalidades de evaluación y tratamiento propuestos. Revisamos nuestros resultados tras 14 años de experiencia en el manejo laparoscópico. Material y métodos. Estudio retrospectivo de las laparoscopias realizadas en nuestro servicio por teste no palpable entre los años 1996 y 2009. De 174 laparoscopias encontramos 72 testes intraabdominales (5 bilaterales) y realizamos 25 descensos directos (3 bilaterales). En 5 casos se realizó Stephens-Fowler en un tiempo. A 40 pacientes se les realizó la técnica de Stephens-Fowler en 2 tiempos (2 bilaterales) por no alcanzar el orificio inguinal contralateral. El segundo tiempo en 4 casos se realizó asistido por laparoscopia y, en el resto, vía inguinal exclusivamente. La edad media de la primera intervención fue de 3,7 años y el tiempo medio entre las 2 intervenciones fue de 10,9 meses. De los 42 testes descendidos, 22 fueron derechos y 20 izquierdos. El tiempo medio de seguimiento ha sido de 24 meses. Resultados. De los 42 Stephens-Fowler en 2 tiempos realizados, en 27 casos el resultado fue muy bueno con un testículo de tamaño igual al contralateral, 7 bueno con teste más pequeño (hasta 50% de volumen del contralateral) y 7 malos con teste atrófi co. No hubo complicaciones durante la cirugía. Conclusiones. En el testículo no palpable es indiscutible la utilidad de la laparoscopia y la técnica de Stephens-Fowler en 2 tiempos para los testes intraabdominales con vasos muy cortos debería ser el procedimiento de elección debido a su alta tasa de éxito.
The management of intra-abdominal testis can be challenging, as evidenced by the multiple methods suggested for its assessment and treatment. In this paper, we report our long-term results for our 14-year surgical experience with laparoscopic management. Methods. Retrospective study of laparoscopic interventions performed at our department for nonpalpable testes between 1996 and 2009. In 174 procedures, we found 72 intra-abdominal testes (5 bilateral) and 25 direct orchiopexies (3 bilateral) were performed. One-stage Fowler-Stephens orchiopexies (FSO) were performed in 5 children. 40 boys underwent the two-stage FSO technique (2 bilateral) in those that reached the contralateral inguinal ring. The second stage was performed in 4 cases with a laparoscopic approach, the rest of them underwent an inguinal procedure exclusively. Mean age for the first intervention was 3.7 yrs, and the second stage was performed on average after 10.9 months. Of 42 undescended testes, 22 were on the right side and 20 on the left side. Median followup was 24 months. Results. Of 42 two-stage FSOs performed, 27 surgeries were very successful, with a testis size equivalent to the contralateral mate; 7 had good results, with a smaller testis (volume up to 50% of contralateral); and 7 resulted in atrophic testis. No complications were encountered during surgery. Conclusions. There is no doubt about the usefulness of laparoscopy for intra-abdominal testes with short spermatic vessels, and the two-stage Fowler-Stephens technique should be the procedure of choice given its high success rate.
The management of intra-abdominal testis can be challenging, as evidenced by the multiple methods suggested for its assessment and treatment. In this paper, we report our long-term results for our 14-year surgical experience with laparoscopic management. Methods. Retrospective study of laparoscopic interventions performed at our department for nonpalpable testes between 1996 and 2009. In 174 procedures, we found 72 intra-abdominal testes (5 bilateral) and 25 direct orchiopexies (3 bilateral) were performed. One-stage Fowler-Stephens orchiopexies (FSO) were performed in 5 children. 40 boys underwent the two-stage FSO technique (2 bilateral) in those that reached the contralateral inguinal ring. The second stage was performed in 4 cases with a laparoscopic approach, the rest of them underwent an inguinal procedure exclusively. Mean age for the first intervention was 3.7 yrs, and the second stage was performed on average after 10.9 months. Of 42 undescended testes, 22 were on the right side and 20 on the left side. Median followup was 24 months. Results. Of 42 two-stage FSOs performed, 27 surgeries were very successful, with a testis size equivalent to the contralateral mate; 7 had good results, with a smaller testis (volume up to 50% of contralateral); and 7 resulted in atrophic testis. No complications were encountered during surgery. Conclusions. There is no doubt about the usefulness of laparoscopy for intra-abdominal testes with short spermatic vessels, and the two-stage Fowler-Stephens technique should be the procedure of choice given its high success rate.
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Citation
Cir Pediatr 2011; 24: 179-181
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