الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Although it has been recognized over a century ago, the abdominal testis remains to be a major challenge to pediatric surgeons as a surgical paradigm. Even though many surgical procedures have been described to address this problem, yet none has achieved supremacy in the clinical context. The absence of a worldwide consensus on a management protocol not only emerges from lack of an ideal surgical technique or imaging tools, but also from incomplete understanding of the interplay of genetic, physiological and hormonal mechanisms involved in testicular descent.
The short-term clinical outcome of the laparoscopic traction- lengthening for abdominal testes in a single center over a 12 months period (January - December 2015). An ethical approval of the study & appropriate consents were obtained for all patients before inclusion in our study .
A total of 47 consecutive boys presented with impalpable testes in the ipsilateral hemi scrota, 3 of them were bilateral summing up to a total of 50 units of abdominal testes to a single center over 12 months (January - December 2015). Those underwent a preoperative U/S Doppler scan for the ipsilateral & contralateral testes. Then proceeded to a 1st stage laparoscopic exploration for the testes in which the cranial testicular artery & the caudal vas deferens were traced to their meeting point to locate the abdominal testes that were either found (peeping at the internal inguinal ring or more cranially) or otherwise vanishing (intra abdominally blind-ending vas & vessels or extra abdominally passing through the internal inguinal ring). 7 testes stay at the contralateral IIR when brought there mandating a preliminary lengthening of the testicular vessels by lateral dissection, traction & fixation to a point 1-2 cm superolateral to the
Summary
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contralateral anterior superior iliac spine (ASIS) for 43 testes, essentially a mobile traction point. After 12 weeks, 43 testes underwent a 2nd stage laparoscopic-assisted ipsilateral subdartos orchidopexy for the testes under traction. Occasional slippage of the testis-under-traction mandated an otherwise 2nd stage re-traction & a 3rd stage orchidopexy. All underwent U/S Doppler scan 3 & 6 months after orchidopexy. The 50 cryptorchid boys presented at a mean age of 3 years 2 months (range: 6 months - 8 years). Out of the 50 impalpable testes, 7 were fixed directly to scrotum excluded from our study and the rest (43) testes fixed loosely near the contralateral ASIS in the 1st stage laparoscopic exploration. Whichenter the 2nd stage . The 12 weeks traction interval went uneventfully and a pre-definitive U/S Doppler scan confirmed viability of all testes under traction.38 testes elongated were mobilized & fixed in the ipsilateral hemi scrotal.and 5 testes slpet and retraction done and fixation at 3rd stage. All 43 fixed testes were confirmed viable on U/S Doppler scan 3 & 6 months after orchidopexy.
The technique of staged laparoscopic traction-lengthening for abdominal testes is safe, easy and convenient as evidenced by our limited early experience. Neither internal herniation complicated the traction period nor testicular atrophy (by undue tension) complicated the traction or follow-up periods. We advocate this technique as an alternative to the de facto Fowler-Stephens staged orchidopexy that entails risky division of the testicular vessels.