Groin exploration for nonpalpable testes: laparoscopic approach.

PURPOSE: Diagnostic laparoscopy (DL) is the technique of choice for exploration of nonpalpable testes (NPT). Nevertheless, groin exploration is necessary to evaluate the cord and gonadal structures entering the internal ring. This retrospective analysis evaluates our hypothesis that hypoplastic cord structures entering the internal ring predicts absence of a viable testicle and a laparoscopic groin exploration in these cases can reduce the number of unnecessarily performed open groin exploration (OGE). MATERIALS: A retrospective review was performed of 23 boys with 26 NPTs who were operated on from June 1998 to October 2000 to evaluate our protocol for NPT using DL and OGE. RESULTS: Of 26 NPTs in 23 boys, 3 bilateral intraabdominal testis were detected (2 Fowler Stephens; 1 standard orchidopexy). Twenty cord structures entered the internal ring. Three appeared normal at DL with a viable testis followed by an orchidopexy. Seventeen were hypoplastic without patent processus. During LGE no viable testis was detected: blind-ending cords, no biopsy (n = 4); testicular regression syndromes (n = 3), early fetal regression (n = 6), no residual testicular structures (n = 4). CONCLUSIONS: This experience confirms the authors' hypothesis and criteria for LGE in all cases. The authors conclude that LGE is a helpful tool in the diagnostic workup of NPT to avoid unnecessary OGE and is a further step in the minimally invasive approach to all kinds of findings of NPT.

[Thyroglossal duct cysts in paediatric patients: early operative intervention reduces rate of complications]. / Mediane Halszysten im Kindesalter: frühzeitige Operation senkt die Komplikationsrate.

BACKGROUND: Thyroglossal duct cysts arise from mucus production in an incomplete regressed thyroglossal duct. Often they are only noticed in case of infection or secondary fistulation. The operative management is a Sistrunk procedure. METHOD AND PATIENTS: In a retrospective study we analyse 26 patients aged 0,3 - 10 years with histological confirmed thyroglossal duct cysts, 13 of these (50 %) had signs of infection. In 15 patients the cyst was primarily cored out, in 11 patients the core out followed a primarily incision and drainage. RESULTS: 5 patients (19 %) developed recurrent cysts. Patients with signs of infection or incomplete resection of hyoid bone had a high risk of developing recurrence. CONCLUSIONS: We propose an early operative treatment for thyroglossal duct cysts with a complete Sistrunk procedure.

An easy method for laparoscopic-assisted percutaneous anterior gastropexy.

Laparoscopic antireflux surgery is becoming a standard procedure in pediatric surgery. Anterior gastropexy is often performed in antireflux procedures, as well as in children with recurrent and intermittent volvulus of the stomach. We present a simple and secure technique for anterior laparoscopic-assisted gastropexy.