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

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

2 Page 2 Cryptorchidism is a common finding in pediatric practice,

3 Page 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 Page 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 Page 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 Page 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 Page 7 Patients 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.

8 Page 8 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

9 Page 9 Intra Canalicular Testes Intra abdominal testes are classified according to the laparoscopic findings Result And Discussion

10 Page 10 Intra Abdominal Testis Are Classified According To The Laparoscopic Findings Intra Abdominal Testis

11 Page 11 vanished testes Intra Abdominal Testis Are Classified According To The Laparoscopic Findings

12 Page 12 Teratoma

13 Page 13 Persistent Miillerian Duct Structures

14 Page 14 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

15 Page 15 36 PATIENTS (42 IMPALPABLE TESTES) 15 Testes Absents Vanished 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 Discussion

16 Page 16 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

17 Page 17 %F. S Procedure Assisted Laparoscopic Orchiopexy Condition Of The Testis 75513Good size 21.81 one stage4Small size 4.201Atrophy 100618Total 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.

18 Page 18 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. Conclusion

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