Fowler-Stephen Orchidopexy

Undescended testis (UT) is the most common congenital anomaly of the genitalia of newborn males. It is more common in prematurely born infants. It is estimated that 20% of undescended testis are non-palpable. Non-palpable UT might be intraabdominal, canalicular, atrophic or absent. Orchidopexy in UT should be performed before the age of 18 months to avoid damage to spermatogonia. Diagnostic laparoscopy is the gold standard maneuver to determine localization and eventual management of non-palpable UT. Laparoscopy is better than CT-Scan, MRI, gonadal arteriography or venography in localizing the presence, distance and size of a nonpalpable UT. Blind ending vessels without a distal testis determine absence and no further management is required. If vessels and vas enter the internal spermatic ring, the child probably has a canalicular testis or nubbin in either case it should be moved and fixed to the scrotum or removed respectively suing an inguinal incision. Atrophic or hypoplastic testes are removed during the diagnostic procedure. Intraabdominal testes are either brought down to the scrotum and fixed if the vascular pedicle permits such maneuvers (laparoscopic assisted orchidopexy) or staged its descent using Fowler-Stephen technique (FST). Two-stage FST is performed if the testis is at a high position estimated as more than 2 centimeters between the manipulated testis and the internal ring. The technique consists of clamping and dividing the vascular supply to the testis and leaving it alone so that collateral blood supply develops from the vas deferens. FST can be performed one or two staged procedure. The one-stage FST preserved the gubernaculum for additional collateral blood supply. In the second stage of FST orchidopexy is performed six months later descending the testis with vas deferens-based circulation by fixing it to the scrotum using laparoscopy and inguinal surgery. Success rate for one stage FST can approach 70% which are encouraging. The most common complication after performing either FST is testicular atrophy. 

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         Icteropyloric Syndrome

*Edited by: Humberto Lugo-Vicente, MD, FACS, FAAP
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Journal Club
Pediatric Surgery Update ISSN 1089-7739
Last updated: November 2017