Orchiopexy—Laparoscopic Overview

Sometimes, baby boys are born with one or both testicles inside the abdomen or groin, rather than in the scrotum. This is called undescended testicles . Orchiopexy is a surgery to lower the testicle(s) into the scrotum. The scrotum is the external sac that holds the testicles.

Undescended testes

Prior to Procedure

Your child’s doctor and anesthesiologist will do the following:

• Physical exam

• Imaging, blood, and urine tests

• Discuss the anesthesia being used and the potential risks

• Discuss the risks of surgery and answer any questions

Talk to the doctor about your child’s medicines or any recent illnesses. You may be asked to have your child stop or start certain medicines before surgery.

Other things to keep in mind before the procedure include:

• Bring special toys, books, and comfortable clothing for your child.

• Your child will need to avoid eating for a period of time before surgery. Ask the doctor when your child should stop eating and drinking. For children younger than one year, it is often recommended that they do not eat after midnight the night before the surgery. Clear liquids (eg, breast milk, water, clear juices) may be allowed up to two hours before the procedure.

Anesthesia

General anesthesia will be used. Your child will be asleep during the surgery. He will not feel any pain.

Description of the Procedure

Once your child is asleep, the doctor will make small keyhole incisions in one or both sides of the groin and in the abdomen. He will use tiny laparoscopes. These are thin, long tools that allow the doctor to view and operate inside the body. First, the doctor will locate and examine the testicle. If there is a hernia present, this will also be fixed.

Next, the doctor will create a pouch in the scrotum. The testicle will be pulled down into the newly created pouch. Stitches will hold the testicle in place. The stitches will dissolve on their own. All other incisions will also be closed with stitches.

In some cases, a small button will be placed on the outside of the scrotum with stitches. The button will hold the testicle down until healing occurs. The doctor removes the button by cutting the stitches a few weeks after the procedure.

In most cases, your child can go home from the hospital on the same day as the surgery.

How Long Will It Take?

1 hour per testicle

How Much Will It Hurt?

Anesthesia prevents pain during the procedure. The doctor will give pain medicine after the surgery.

Post-procedure Care

At the Care Center

• Your child will be monitored while he recovers from the anesthesia.

• The nurse will give pain medicine as needed.

At Home

When your child returns home, do the following to help ensure a smooth recovery:

• Give medicines to treat pain and prevent infection as directed.

• Minor bleeding is normal. Care for the incisions as directed by the doctor.

• If you child wears a diaper, change it often. Leave it off for short periods to allow air at the incision sites.

• Engage in gentle play. Avoid tiring activities for a few weeks. Your child should avoid sitting on or riding a bicycle for about a week after the surgery.

• Monitor your child for signs of pain. These may include fussiness, trouble moving, sweating, or pale skin.

• Be sure to follow the doctor’s instructions.

After you leave the hospital, contact the doctor if any of the following occurs:

• Increasing pressure or pain

• Redness, drainage, puffiness, or soreness around the incision site(s)

• Changes in frequency, odor, appearance, or volume of urine

• Difficulty urinating

• Signs of infection, including fever or chills

• Vomiting

• Abdominal pain

• Lack of energy

• Loss of appetite

In case of an emergency, CALL 911.

RESOURCES:

American Academy of Pediatrics
http://www.aap.org/

American Family Physician
http://www.aafp.org/afp/

CANADIAN RESOURCES:

Canadian Pediatrics Society
http://www.cps.ca/

Health Canada
http://www.hc-sc.gc.ca/index-eng.php

References:

Elyas R, Guerra LA, Pike J, et al. Is staging beneficial for Fowler-Stephens orchiopexy? A systematic review. J Urol. 2010;183(5):2012-2018.

Orchiopexy. Children’s Hospital and Clinics of Minnesota website. Available at: http://www.childrensmn.org/Manuals/PFS/Surg/018757.pdf . Accessed August 16, 2010.

Orchiopexy: surgery for undescended testicles. About Kids Health website. Available at: http://www.aboutkidshealth.ca/healthaz/Orchidopexy-Surgery-for-Undescended-Testicles.aspx?articleID=10179&categoryID=AZ1k . Accessed August 16, 2010.

Smith N, Carmack A. Undescended testes. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=1034 . Updated July 1, 2010. Accessed August 16, 2010.

Undescended testicle orchiopexy repair surgery. Children’s Hospital of Pittsburgh website. Available at:
http://www.chp.edu/cs/Satellite?c=eHAContentC&cid=1209404825839&pagename=CHP/eHAContentC/CHP/Template/CHPLayout04ContentPage_Template . Accessed August 16, 2010.

Wein AJ. Campbell-Walsh Urology.9th ed. Philadelphia, PA: Elsevier Saunders; 2007.