The value of 2-step laparoscopic Fowler-Stephens orchiopexy for intrabdominal testes

Purpose: We report our experience in the treatment of high intra-abdominal testis with a complete laparoscopic 2-stage Fowler-Stephens procedure with associated transperitoneal closure of the internal ring in pediatric patients. Materials and Methods: Between 1990 and 1997, 100 boys with 105 nonpalpable testes underwent laparoscopy. Laparoscopy showed intra-abdominal testis in 40 cases. In 5 cases when the testis was just proximal to the internal ring, we performed standard orchiopexy. In 35 cases with the testis in the high intra-abdominal position, we performed the Fowler-Stephens procedure with the first stage performed laparoscopically. To date, all 35 testis have undergone the second phase after 6 to 12 months (2 by open technique, 33 by laparoscopy). The last 33 patients underwent the second phase of the 2-stage Fowler-Stephens procedure by laparoscopy with associated video surgical transperitoneal closure of internal ring. Results: All testes were successfully placed in the scrotum. At a mean 30 months of followup, with clinical examination, ultrasonography and comparative colorimetric echo Doppler study, all testes were viable in the scrotum, except for 1 that became atrophic 2 months after the second open phase of 2-stage Fowler-Stephens technique. Conclusions: Our early results suggest that the 2-stage Fowler-Stephens procedure, performed completely using laparoscopy, is a feasible technique for treating high intra-abdominal testis.