Laparoscopy in the management of impalpable undescended testis

Impalpable undescended testes offer a greater diagnostic and therapeutic challenge for the radiologist and the surgeon. Evaluation of the impalpable testis using diagnostic laparoscopy has received appreciable support in the last years. Laparoscopy to evaluate the impalpable testis has also a great impact on treatment. In this study 36 children with impalpable testes underwent diagnostic and therapeutic laparoscopy for evaluation of impalpable testis. 9 patients had bilateral and 27 patients had unilateral impalpable undescended testis. The left testis was affected in 16 boys and the right in 11. Laparoscopy localized 29 [64.4%] testes out of 45 impalpable testes and 16 [35.6%] blind ended vas deferens. Two-stage Fowler-Stephens orchidopexy was performed in 6 testes [4unilateral and 1 bilateral cases]. The remainder, or 23 intra-abdominal testes [79.3%], were mobilized sufficiently to allow scrotal placement without dividing the testicular vessels. The overall success rate for all Fowler-Stephens procedures was 83.3% [5 out of 6], for all single stage laparoscopic orchidopexies was 91.3% [21 out of 23] and for all laparoscopic procedures was 89.66% [26 out of 29] where 26 out of 29 testes were placed successfully in the scrotum with no atrophy. Laparoscopy for the impalpable undescended testis offers a simultaneous diagnostic and therapeutic tool. It obviates the need for invasive and/or expensive diagnostic imaging and saves the patient an extensive surgical procedure. This study recommends laparoscopic orchidopexy as the treatment of choice for the impalpable undescended testis

Minimally invasive repair of late presenting congenital diaphragmatic hernia in children

Patients with congenital diaphragmatic hernia usually present in the immediate neonatal period with respiratory distress. Delayed presentations of congenital hernia occurring outside of the neonatal period have been reported for all ages. Classically, repair of the hernial defect involves a transverse subcostal laparotomy in the pediatric age group. The first report describing a laparoscopic repair of a congenital diaphragmatic hernia in a 6-month-old infant was published in 1995. Since then there is growing experience with a minimal access approach to these defects. During the past 4 years, minimally invasive repair was used to treat 18 patients with delayed presentation of congenital diaphragmatic hernias at Cairo University specialized pediatric hospital. All defects, but one were directly sutured without the use of a mesh. All patients were healthy without signs of recurrence observed at chest X-ray after a follow-up of 7 to 22 months. Minimally invasive approach for the repair of delayed-presentation congenital diaphragmatic hernia is feasible. Although experience is still limited, the results of this study demonstrate that under specific conditions the laparoscopic approach can be an effective and more advantageous alternative to laparotomy for diaphragmatic congenital diseases in a pediatric population. Benefits include that it provides an excellent view of the surgical field, ease of execution, minimal surgical trauma, excellent cosmetic results, rapid recovery, and shorter hospitalization