Impact of Percutaneous Laparoscopic Assisted Internal Ring Ligation During Lap Orchiopexy
Impact of Percutaneous Laparoscopic Assisted Internal Ring Ligation During Lap Orchiopexy
Impact of percutaneous internal ring ligation during laparoscopic orchiopexy in decreasing
 incidence of congenital hernia
Cryptorchidism is the most common genitourinary anomaly in male children. Its incidence can
 reach 3% in full term neonates, rising to 30% in premature boys . The treatment of the crypt
 orchid testicle is justified by the increased risk of infertility and malignancy, as well as
 an associated inguinal hernia and the risk of trauma to the ectopic testicle against the
 pubis. Furthermore, the psychological stigma of a missing testis for the patient, as well as
 the parents' anxiety is also factors that justify this type of treatment .

 About 20% of crypt orchid testicles are non palpable. The treatment of non-descended
 testicles is mandatory due to the increased risk of infertility, present in up to 40% of the
 patients, as compared to 6% of control groups, including malignancy, which reaches 20 times
 that of normal adults .

 The treatment of the crypt orchid testis before 2 years of age is recommended, treatment is
 necessary not only for the risk of malignancy, but also for the satisfaction and improvement
 in the quality of the patient's life and parents´ concern for their children's health.

 In relation to diagnosis, despite a sensitivity of 70-90% in the diagnosis of inguinal
 testes, ultrasonography is not useful in intra-abdominal cases . Although presenting a better
 quality, both computed tomography and nuclear magnetic resonance lack sufficient sensitivity
 and specificity to be considered as gold standard diagnostic tools . More recently, the
 magnetic angioresonance was introduced with sensibility of 96% and specificity of 100%, but
 it is still a new method, with high costs, also requiring general anesthesia in children .

 In relation to the treatment, the use of gonadotrophin for un descended testes presents a
 success rate of definitive descent to the scrotum of 21 to 56%, with better results in
 bilateral cases . Surgical treatment via an inguinal incision is the main treatment option
 for palpable testicles, but can also be employed for the evaluation and treatment of
 non-palpable testis. In this situation, however, surgical exploration can often require large
 incisions and extensive dissections, especially in bilateral cases. This can be avoided using
 laparoscopic evaluation, with a sensitivity and specificity reaching more than 90%
-  INCLUSION CRITERIA

 1. Age above six months

 2. SEX must be male

 3. Surgical approach is closure of internal ring via percutaneous technique after
 delivery of undescended testis

 -  EXCLUSION CRITERIA

 1. Age less than 3 months

 2. Patients with palpable undescended testis

 3. Any associated major congenital anomalies like cardiac anomalies