Objective: To report success, complication, and atrophy rates, as well as cost analysis and surgeon preference, for standard laparoscopic versus laparoscopic Fowler-Stephens (FS) approaches to intra-abdominal testes.
Patients and methods: The records of children who underwent laparoscopic orchiopexy for impalpable testes at our institution were reviewed. Two groups were assessed: Group 1, who underwent a standard laparoscopic orchiopexy; and Group 2, who underwent either a single-stage or two-stage FS orchiopexy. Success was defined as an intrascrotal testis without atrophy. Cost analysis was performed by obtaining operating room charges for the procedures. Surgeon preference was evaluated by calculating the number of each type of orchiopexy performed.
Results: From 1998 to 2005, 61 laparoscopic orchiopexies were performed on 46 patients. In Group 1, 31 orchiopexies were performed on 22 patients. In Group 2, 30 orchiopexies were performed in 26 patients. Eight orchiopexies were performed on 7 patients in a single stage, whereas 22 orchiopexies in 19 patients were performed in two stages. Two patients underwent both unilateral FS and laparoscopic orchiopexy. Success rates for Groups 1 and 2 were 96.7% and 83.3%, respectively. There were three complications in Group 1 (9.7%) and nine complications in Group 2 (30%). Atrophy rates for the two groups were 6.5% (2/31) and 16.7% (4/24), respectively. The average operating room cost for a standard laparoscopic approach was $3686, $3604 for the first stage and $3909 for the second stage of a two-stage FS approach, and $3785 for a single-stage FS approach.
Conclusions: Data from this series suggest that completing a laparoscopic orchiopexy in a single operation without ligating the testicular vessels has comparable, if not better, success rates to those of FS procedures, while reducing cost and potentially reducing complications. Outcomes between single- and two-stage FS approaches are similar, but the former can be accomplished at half the cost.