Presentation on theme: "Laparoscopic Management Of Muataz A. Al Ani , Bassam Kh. Al Abassy"— Presentation transcript:
1 Laparoscopic Management Of Muataz A. Al Ani , Bassam Kh. Al Abassy Impalpable TestesIn Pediatric Age GroupMuataz A. Al Ani , Bassam Kh. Al AbassyPediatric Surgeons
2 IntroductionCryptorchidism is a common finding in pediatric practice ,
3 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.
4 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.
5 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.
6 Aim 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 .
7 Patients And MethodsThroughout 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.
8 Ports 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.
9 Result And Discussion Intra Canalicular Testes Intra abdominal testes are classified according to the laparoscopic findingsIntra Canalicular Testes
10 Intra Abdominal Testis Are Classified According To The Laparoscopic Findings
11 Intra Abdominal Testis Are Classified According To The Laparoscopic Findings vanished testes
14 A viable intra-abdominal testis The limiting factor to relocate the intra-abdominal testis to the scrotum isthe length of the gonadal vessels.Assisted laparoscopic orchiopexy.Single stage Fowler-Stephen technique.Two stage Fowler-Stephen technique.
15 Result And Discussion 36 PATIENTS (42 IMPALPABLE TESTES) 27 Testes Were Positive15 Testes AbsentsVanished Testes12 Vas And Vessel Enter The Internal Ring3 With No Vas And Vessel Entering The Ring (Agenesis).
16 27 Testes Positive 16 Near The Internal Inguinal Ring 2 Testes Intra Canaliculare9 In The Iliac FosseAssisted laparoscopic orchiopexySingle stage Fowler-Stephen technique in 4 testesTwo stages Fowler-Stephen technique in 2 testesBiopsy In 3 testes
17 Assisted Laparoscopic Orchiopexy Condition Of The Testis 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.%F. S ProcedureAssisted Laparoscopic OrchiopexyCondition Of The Testis75513Good size21.81 one stage4Small size4.21Atrophy100618Total
18 Conclusionlaparoscopy 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.