Page 1Muataz A. Al Ani , Bassam Kh. Al Abassy

Pediatric Surgeons

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Cryptorchidism is a common finding in pediatric practice ,

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21% of preterm male infant. 1.8-4 % of full term boys.

0.8% of 1 year old boys.

The proportion of impalpable testis has been reported up to 20% of all cryptorchied boys.

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A variety of imaging modalities have been used to detect the impalpable testis,

Ultrasound, Computed tomography, Magnetic resonance imaging, Arterography and venography.

Non are as sensitive as laparoscopy for accurate localization of the intra abdominal testes.

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Cortesi et al first reported the use of laparoscopy in the surgical management of impalpable testes in 1976.

Initially, laparoscopy was used only for localization before open surgical exploration. It is only recently that laparoscopy been deemed a means of both diagnosis and treatment.

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Aim Of The StudyAim Of The Study

The purposes of our study was: To evaluate the role of laparoscopy in localizing impalpable testes.

The management strategy for both unilateral and bilateral impalpable testes .

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Patients And MethodsPatients And Methods

Throughout the period between January 2005 to December 2008 ,

A 36 patients with impalpable testes were admitted to the pediatric surgery centre at Al khansa teaching hospital in Mosul /Iraq ,

Laparoscopy done for them to assess and manage 42 impalpable testes.

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5-10 mm supra-umbilica port for 0ºtelescope

For diagnostic laparoscopy: at least an additional port is needed.

For therapeutic management: additional 2 working ports in the flanks.

Ports

Page 9Intra Canalicular Testes

Intra abdominal testes are classified according to the laparoscopic findings

Result And DiscussionResult And Discussion

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Intra Abdominal Testis Are Intra Abdominal Testis Are Classified According To The Classified According To The

Laparoscopic Findings Laparoscopic Findings

Intra Abdominal Testis

Page 11vanished testes

Intra Abdominal Testis Are Intra Abdominal Testis Are Classified According To The Classified According To The

Laparoscopic Findings Laparoscopic Findings

Page 12Teratoma

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Persistent Miillerian Duct Structures

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The limiting factor to relocate the intra-abdominal testis to the scrotum is the length of the gonadal vessels. Assisted laparoscopic orchiopexy. Single stage Fowler-Stephen technique.

Two stage Fowler-Stephen technique.

A viable intra-abdominal testis

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36 PATIENTS (42 IMPALPABLE TESTES)

15 Testes AbsentsVanished Testes

3 With No Vas And Vessel Entering The

Ring (Agenesis).

12 Vas And Vessel Enter The Internal

Ring

27 Testes Were

Positive

Result And DiscussionResult And Discussion

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27 Testes Positive

2 Testes Intra

Canaliculare

9 In The Iliac Fosse

16 Near The Internal

Inguinal Ring

Single stage Fowler-Stephen technique in 4

testes

Two stages Fowler-Stephen technique in 2

testes

Assisted laparoscopic orchiopexy

Biopsy In 3 testes

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Condition Of The Testis

Assisted Laparoscopic

Orchiopexy F. S Procedure %

Good size 13 5 75Small size 4 1 one stage 21.8Atrophy 1 0 4.2Total 18 6 100

We followed our patients for about two years by assessing the size of the fixed testis in comparism to the other one and in relation to patient age.

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laparoscopy has a safe, reliable and accurate role in management of impalpable testis .

It also direct the surgeon to chose the proper technique for orchiopexy .

One stage assisted laparoscopic orchiopexy.

Single stage Fowler Stephen laparoscopic orchiopexy .

Two stages Fowler Stephen laparoscopic orchiopexy.

ConclusionConclusion

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