ABSTRACT
El manejo del testículo intraabdominal puede ser difícil, como lo demuestran las múltiples modalidades de evaluación y tratamiento propuestos. Revisamos nuestros resultados tras 14 años de experiencia en el manejo laparoscópico. Material y métodos. Estudio retrospectivo de las laparoscopias realizadas en nuestro servicio por teste no palpable entre los años1996 y 2009. De 174 laparoscopias encontramos 72 testes intraabdominales (5 bilaterales) y realizamos 25 descensos directos (3bilaterales). En 5 casos se realizó Stephens-Fowler en un tiempo. A40 pacientes se les realizó la técnica de Stephens-Fowler en 2 tiempos(2 bilaterales) por no alcanzar el orificio inguinal contralateral. El segundo tiempo en 4 casos se realizó asistido por laparoscopiay, en el resto, vía inguinal exclusivamente. La edad media de la primera intervención fue de 3,7 años y el tiempo medio entre las 2intervenciones fue de 10,9 meses. De los 42 testes descendidos, 22 (..) (AU)
The management of intra-abdominal testis can be challenging, as evidenced by the multiple methods suggested for its assessment and treatment. In this paper, we report our long-term results for our 14-yearsurgical experience with laparoscopic management. Methods. Retrospective study of laparoscopic interventions performed at our department for non palpable testes between 1996and 2009. In 174 procedures, we found 72 intra-abdominal testes (5bilateral) and 25 direct orchiopexies (3 bilateral) were performed. One-stage Fowler-Stephens orchiopexies (FSO) were performed in 5children. 40 boys underwent the two-stage FSO technique (2 bilateral)in those that reached the contralateral inguinal ring. The second stage (..) (AU)
Subject(s)
Humans , Male , Child, Preschool , Child , Cryptorchidism/surgery , Laparoscopy/methods , Orchiopexy/methods , Retrospective Studies , Postoperative Complications/epidemiology , Urogenital Abnormalities/surgeryABSTRACT
The management of intra-abdominal testis can be challenging, as evidenced by the multiple methods suggested for its assessment and treatment. In this paper, we report our long-term results for our 14-year surgical experience with laparoscopic management. Methods. Retrospective study of laparoscopic interventions performed at our department for nonpalpable testes between 1996 and 2009. In 174 procedures, we found 72 intra-abdominal testes (5 bilateral) and 25 direct orchiopexies (3 bilateral) were performed. One-stage Fowler-Stephens orchiopexies (FSO) were performed in 5 children. 40 boys underwent the two-stage FSO technique (2 bilateral) in those that reached the contralateral inguinal ring. The second stage was performed in 4 cases with a laparoscopic approach, the rest of them underwent an inguinal procedure exclusively. Mean age for the first intervention was 3.7 yrs, and the second stage was performed on average after 10.9 months. Of 42 undescended testes, 22 were on the right side and 20 on the left side. Median followup was 24 months. Results. Of 42 two-stage FSOs performed, 27 surgeries were very successful, with a testis size equivalent to the contralateral mate; 7 had good results, with a smaller testis (volume up to 50% of contralateral); and 7 resulted in atrophic testis. No complications were encountered during surgery. Conclusions. There is no doubt about the usefulness of laparoscopy for intra-abdominal testes with short spermatic vessels, and the two-stage Fowler-Stephens technique should be the procedure of choice given its high success rate.
Subject(s)
Cryptorchidism/surgery , Laparoscopy , Adolescent , Child , Child, Preschool , Humans , Infant , Male , Retrospective Studies , Time Factors , Urologic Surgical Procedures, Male/methodsSubject(s)
Humans , Male , Infant , Fibrous Dysplasia, Polyostotic/diagnosis , Orchitis/etiology , Sertoli CellsABSTRACT
Many procedures are described to solve the problem of the massive hemorrhages due to esophageal varices in children with Portal Hypertension in which it's not possible to do a porto-systemic shunt by cause of the age. It's possible to treat them by sclerotherapy but in case of massive hemorrhages in which the patient life is at risk we have used the azygo-portal disconnection following the SUGIURA technique making the esophageal transection with autosuture instrument. We believe that this technical simplification account for more instances in which it's indicated. And it could be preferred to other procedures used with the same objective. We have done it in two male patients which came to our Center in several occasions due to massive hemorrhages. In both cases the Portal Hypertension is of extrahepatic cause. Follow up it is been satisfactory in both cases. Being one of them more than 3 1/2 years without hemorrhagic episodes, remaining under clinical and endoscopic controls. We have used in this cases the Proximate ILS of 21 mm. of Ethicon.
