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Posterior Approach to the Processus Vaginalis in Orchidopexy
Background
The most critical step in an orchiopexy in achieving spermatic cord length is the separation of the processus vaginalis from the vas deferens and spermatic vessels. We report our experience with a posterior approach to the separation of the processus vaginalis. Our hypothesis was that the posterior approach to the processus vaginalis is comparable in surgical outcome measures to the more traditional anterior approach.
Methods
Following internal review board approval, we retrospectively reviewed medical records of consecutive patients who underwent orchidopexy at Hasbro Children’s Hospital between January 2006 and July 2012. Exclusion criteria included previous ipsilateral inguinal surgery and laparoscopic orchidopexy. Only patients with 6-month follow up were included in the study. Patients were divided into posterior and anterior surgical approach groups and operative outcomes were compared. The major endpoints at 6-month follow up included ipsilateral testicular atrophy, secondary reascension, and hernia recurrence. Additionally, a number of surgical variables were also considered, including gestational age, Tanner stage, presence of co-morbidities at the time of procedure, pre-operative and intra-operative testis location, and duration of procedure.
Results
A total of 340 patients underwent orchidopexy who satisfied inclusion criteria within the time frame of our study. Of these patients, 191 and 149 underwent posterior and anterior approach orchidopexies, respectively. Follow up at 6 months revealed 1 case of testicular atrophy and 2 cases of secondary reascension in the posterior and anterior approach groups, respectively. Logistic regression analysis did not demonstrate significant difference in outcome superiority between the two groups (P>0.2061).
Conclusions
In our study we have objectively determined that the posterior approach orchidopexy has the same surgical outcomes to the anterior approach, and thus is a viable surgical alternative. We believe the posterior approach to be more anatomical and easier to teach.