title: Orchiopexy after prior inguinal surgery: a distal approach.
abstract: OBJECTIVE
  Undescended testicle after groin surgery is a condition traditionally approached through an inguinal incision with en bloc mobilization of the spermatic cord and external oblique fascia, and extensive dissection of the proximal spermatic vessels. We report on a single surgeon series of orchiopexies after prior inguinal surgery approached through a single scrotal incision.
  
  
  METHODS
  From November 2001 to February 2007, 24 patients with a mean age of 6.4 years (range 1.3 to 16.2) presented with 27 undescended testicles. All patients had undergone previous groin surgery including 13 inguinal hernia repairs, 3 orchiopexies and 3 hernia repairs with orchiopexy. Of the 27 testicles 24 (21 patients) were successfully approached through a single scrotal incision (89%). If the scrotum could not be manipulated over or near the relatively fixed testicle, an inguinal incision was made (11%). Charts were retrospectively reviewed for technique and operative outcomes.
  
  
  RESULTS
  A mean followup of 12 months was available for 20 of 21 patients. A patent processus vaginalis was found in 3 (12.5%) patients and hernia repair was performed through the scrotal incision in these patients. There were no intraoperative complications. In 1 (4.2%) patient the testicular position was unacceptable and subsequently successful repeat scrotal orchiopexy was performed. At last followup all testes were in a satisfactory scrotal position without hydrocele, hernia or testicular atrophy.
  
  
  CONCLUSIONS
  The majority of orchiopexies after prior inguinal surgery can be approached through a single scrotal incision. Retrograde serial dissection of adhesions to the distal cord usually reveals adequate vessel length, thus avoiding extensive inguinal and/or retroperitoneal dissection.
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15201, USA. dudleyag@upmc.edu
authors.forename: Anne G
authors.initials: AG
authors.lastname: Dudley
authors.forename: Danielle D
authors.initials: DD
authors.lastname: Sweeney
authors.forename: Steven G
authors.initials: SG
authors.lastname: Docimo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000601:surgery*; D006119:Groin; D006801:Humans; D007223:Infant; D008297:Male; D056126:Orchiopexy; D012086:Reoperation; D012189:Retrospective Studies; D013521:Urologic Surgical Procedures, Male / Q000379:methods