RESUMEN
During laparoscopy for impalpable testes [IT], if the vas and vessels were found exiting the deep ring, many surgeons proceed to inguinal exploration as a routine, regardless the presence or absence of the processus vaginalis [PV] or the adequacy of the vessels. This is to detect an impalpable intra-canalicular testis with possible orchidopexy; if the testis is normal, or excision of a small atrophic testicular remnant; for fear of possible malignant changes later on. It is agreed that in cases of normal testicular vessels the exploration of the inguinal canal should follow. However, with hypoplastic vessels, the need for groin exploration has been questioned. The aim of this study is to assess whether routine inguinal exploration is necessary in all cases of normal vas and hypoplastic vessels passing through the deep inguinal ring during laparoscopy for IT. This is a retrospective study of cases of IT managed by the authors, where during laparoscopy, the vas deferens and the gonadal vessels; were seen passing through the deep inguinal ring. Cases were divided into 4 groups according to the condition of the PV; present [patent or closed] or absent, and the adequacy of the vessels. Findings at inguinal exploration, which was routinely done in all cases, as well as at histo-pathological examination, when done, were compared. The ends of the cord structures were "biopsied" and submitted to histo-pathological study. Cases with hypoplastic vessels were particularly compared in relation to the presence or absence of any testicular tissue on histo-pathological examination. Over a period of 4 years; 27 children had laparoscopy for 36 impalpable testes. Twenty-three cases [64%] had the vas and vessels passing through the deep ring. Eleven cases [48%] had hypoplastic vessels. Five cases [22%] had PV and on inguinal exploration, 3 cases [60%] had atrophic testes, and 2 had small "nubbin" [with calcification and fibrosis on histo-pathology] that were excised. Six cases [26%] had no PV; with 3 having blind ended vas and vessels and 3 having a small "nubbin". No case in the last group showed testicular tissue on histo-pathology. In cases of hypoplastic vessels exiting the deep inguinal ring, it is the presence or absence of PV that should determine the next step. If the PV is present, the possibility of finding an atrophic testicular tissue, which should be excised for fear of malignant changes, is high and inguinal exploration should follow. If the PV is absent, this possibility is not there, and inguinal exploration is unnecessary