title: Is it necessary to close the peritoneum over the deep inguinal ring during laparoscopic orchidopexy?
abstract: BACKGROUND
  During laparoscopic orchidopexy, some authors routinely close the peritoneum over the area of the deep inguinal ring (DIR). We report our experience, to determine whether leaving the peritoneum over the DIR without closure is associated with an increase in the occurrence of postoperative inguinal hernia.
  
  
  METHODS
  This is a retrospective review of patients who underwent laparoscopy for impalpable testes in 2004-2010. The patients were divided into two groups: I) cases in whom the peritoneum over the DIR was routinely closed, and II) cases in whom the DIR was left without closure. The patients were followed up in the outpatient clinic.
  
  
  RESULTS
  During the study period, 442 boys underwent laparoscopy for 570 impalpable testes. The testis was found to be 'vanishing' or 'atrophic' in 182 (32%). The mobilized testis passed through the anatomical DIR in 198 (51%), and through a new deep ring in 190 (49%). The DIR was closed (I) in 178 (46%) and left open (II) in 210 (54%) cases. On follow up (mean 50 months for I and 41 months for II), there were no cases of inguinal hernia.
  
  
  CONCLUSIONS
  Closing the peritoneum over the area of the DIR may not be necessary, even in cases where the testis has to be passed through a medially created new deep ring, because of a short cord.
authors.affiliation: Pediatric Surgery Unit, Alexandria Faculty of Medicine, Alexandria, Egypt. ahmedkhairi@hotmail.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khairi
authors.forename: Sameh
authors.initials: S
authors.lastname: Shehata
authors.forename: Nour
authors.initials: N
authors.lastname: El-Kholi
mesh_terms: D002675:Child, Preschool; D003456:Cryptorchidism / Q000601:surgery*; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007264:Inguinal Canal / Q000601:surgery*; D008297:Male; D056126:Orchiopexy / Q000379:methods*; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013737:Testis / Q000601:surgery; D016896:Treatment Outcome