Hypoplastic gonadal vessels exiting the deep ring during laparoscopy for impalpable testes: when is inguinal exploration necessary?
OBJECTIVE
During laparoscopy for impalpable testes (IT), if the vas and vessels are found exiting the deep ring, many surgeons proceed to inguinal exploration as a routine, regardless of the adequacy of the vessels or the presence or absence of the processus vaginalis (PV). We tried to find out whether this was necessary in cases with hypoplastic vessels.


METHODS
This was a retrospective study of cases of IT where during laparoscopy, the vas deferens and the gonadal vessels were seen passing through the deep inguinal ring. Cases were divided into four groups, according to the condition of the PV: present (whether patent or closed) or absent and the adequacy of the vessels. Findings at inguinal exploration and histopathologic examination were compared.


RESULTS
Over a period of 4 years, 27 children had laparoscopy for 36 IT. Twenty-three cases (64%) had the vas and vessels passing through the deep ring. Eleven cases (48%) had hypoplastic vessels: 5 (22%) with PV, and on inguinal exploration, 3 (60%) had atrophic testes, and 2 small "nubbins," and 6 (26%) with no PV; 3 with blind ended vas and vessels and 3 with small "nubbins." No case in the last group showed testicular tissue on histopathology.


CONCLUSIONS
In cases with hypoplastic vessels exiting the deep inguinal ring, it is the presence or absence of PV that should determine the next step. If it is present, inguinal exploration should follow. If it is absent, exploration is unnecessary.
Khairi
Ahmed
A
Pediatric Surgery Unit, Department of Surgery, Alexandria University Faculty of Medicine, Alexandria, Egypt. ahmedkhairi@hotmail.com
Shehata
Sameh
S
Abouheba
Mohamed
M
Soliman
Sherif
S
D001808:Blood Vessels / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000601:surgery*; D006801:Humans; D007223:Infant; D007264:Inguinal Canal / Q000473:pathology*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D013737:Testis / Q000098:blood supply*; D014649:Vas Deferens / Q000473:pathology