Orchiopexy for cryptorchidism

Indications, age, and goal of the intervention

The primary indication for orchiopexy is cryptorchidism, in which the organ is located in an abnormal position—in the inguinal canal. Most often, the patients are children. The main goal of the surgical intervention is to relocate the testis to its natural anatomical bed (the scrotum) and fix it there for normal development and function.

Primary surgical access and management of the hernia sac

The intervention begins with surgical access, which includes opening the anterior wall of the inguinal canal.

Then the surgeon performs the following manipulations with the hernia sac (which is a patent processus vaginalis of the peritoneum):

• Isolation of the hernia sac along its entire length.
• Transverse transection of the sac at a distance of 3–4 cm from the neck, taking care not to injure the spermatic cord elements at the posterior wall.
• The proximal part (neck) is mobilized, suture-ligated, tied off, and transected.
• The distal part is completely excised, except for the area near the lower pole of the testis.

Preparation for lowering and creation of the bed

For convenience of further relocation, the remnants of the hernia sac and the gubernaculum testis (gubernaculum testis) are transfixed with a silk ligature, which is used for traction.

Creation of the scrotal bed is performed as follows:

1. A clamp is carefully introduced into the scrotum through the lower angle of the surgical wound.
2. The instrument blades are spread to form a cavity.
3. A small incision is made at the bottom of the scrotum, the ends of the traction ligature are grasped, and the organ is brought down to the very bottom.

Fixation of the testis and completion of the surgery

A femoro-scrotal anastomosis is used to retain the organ. A longitudinal incision is made on the medial surface of the thigh (strictly at the level of the scrotal bottom) down to the fascia lata of the thigh. The testis is sutured to this fascia through the remaining structures of the hernia sac and gubernaculum testis, after which the edges of the scrotal and thigh skin incisions are sutured.

The final step of the first stage is layered closure of the inguinal canal (plastic repair). The second stage is performed in 6–8 weeks: the formed scar between the scrotum and thigh is excised, and the skin wounds are finally closed.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Anatomical boundaries and walls of the inguinal canal
• Structure and functions of the gubernaculum testis (gubernaculum testis)
• Elements of the spermatic cord and their topography
• Anatomical and surgical structure of the scrotum and its layers
• Layered plastic repair of the inguinal canal for hernias and cryptorchidism

Other topics in the section «Pelvic and Perineal Surgery»

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.