Laparoscopic Ist stage orchiopexy using antiadherent sheet for high abdominal testis

Abstract High undescended testes with short spermatic vessels are not treated with standard orchiopexy and are currently brought to scrotum prevalently after the section of spermatic vessels, according to the Fowler-Stephens procedure. The ischemic risk of that method is elevated and becomes unbearable in bilateral cases. In 2009 an original staged orchiopexy technique was proposed to elongate the whole cord with anti-adherent sheet preserving the spermatic vessels by which a normal scrotal position was successfully gained without any testis loss. Both stages were performed through inguinotomy. In the present article the successful procedure is updated with implementation of laparoscopy in the first stage in a case of extremely high bilateral 4a type abdominal testis. Laparoscopic access was confirmed as valuable both in terms of extended mobilization and coverage of the entire testis vascular supply. The method of progressive cord elongation by using an anti-adherent sheet avoids the excessive atrophy hazard deriving from the Fowler-Stephens procedure in bilateral high abdominal 4a type testes; based on our findings, the latter can benefit also of a laparoscopic approach in the first stage

Simplified video-assisted one-trocar diverting colostomy in pediatric patients

Background: In pediatric age colostomy is mainly temporary and totally diverting, the major indication being neonatal anorectal malformation for which a specific double separated stoma route has been widely popularized. Out of newborn age the reasons for colon diversion in children are less common and the procedures are quite similar to the techniques employed in adults. Laparoscopy for pediatric colostomy has a short history and the original recommended procedure for newborns has been achieved only very recently with a two-trocars technique. Methods: We describe an original one-trocar method to create a double or single totally diverting colostomy avoiding any other abdominal wound at risk for complications. The procedure has been performed on newborns with anorectal malformations as well as on a teenager through minor technical variants. Results: This one-trocar method allowed a quick and safe totally diverting colostomy in every treated patient. There was no complication during surgery and no skin infection in the whole postoperative period; at the end of treatment scars were minimal. Conclusions: This technique is suitable for the specific neonatal double separated colostomy and virtually for every indication of fecal stream diversion in any kind of patient