Spermatic cord torsion after testicular fixation. A different surgical approach and a revision of current techniques.
We present a technique for testicular fixation, based on the development of a new anatomical structure formed exclusively by the visceral and the parietal tunica vaginalis; our pre-clinical experience with this technique performed in guinea pigs and a clinical casuistic of 100 operations in 69 patients (age range: newborns to 25 years, mean 101.43 months) where the principal indications were unilateral torsion, testicular descent and contralateral fixation after orchiectomy. Postoperative follow-up ranged between 4 months and 204 months with a mean of 14.304 months. At their final follow-up, all patients presented normal testicular size, shape, consistency, sensitivity, mobility and intrascrotal position; no patient complained of symptoms related to the operation. The discussion also includes 48 cases of failed testicular fixation which were performed with sutures, vaginal adhesions or dartos-pouch techniques, as reported by 30 different authors. Ages of patients at the primary operation ranged from 3 years to 34 years (mean 14.381 years), at the secondary operation from 10 years to 40 years (mean 19.298 years) and the interval between them ranged from 5 days to 27 years (mean 53.773 months). The causes of the failures, which led us to consider them as unreliable, were absorption of cicatricial tissue, serosal regeneration and loosening of sutures. The sequelae included testicular atrophies, orchiectomies and severely damaged testicles.
Gesino
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Pediatric Surgery, Hospital Interzonal Especializado Materno-Infantil, Mar del Plata, Buenos Aires, Argentina. ajg@infovia.com.ar
Bachmann De Santos
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D000293:Adolescent; D000328:Adult; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000150:complications / Q000601:surgery*; D005500:Follow-Up Studies; D006168:Guinea Pigs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009919:Orchiectomy; D012086:Reoperation; D013086:Spermatic Cord Torsion / Q000209:etiology / Q000601:surgery*; D019738:Surgically-Created Structures; D013536:Suture Techniques; D013737:Testis / Q000601:surgery; D017211:Treatment Failure