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Laparoscopic surgical findings. The right indirect inguinal hernia was found. The hernia orifice was 2 cm sized in diameter.
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Introduction:
Cryptorchidism or undescended testis is the most common disorder of male children, which is often diagnosed and treated during childhood. Adult patients with cryptorchidism are uncommon. Herein we report the case of adult inguinal hernia with cryptorchidism successfully treated by laparoscopic surgery simultaneously.
Presentation of...
Context in source publication
Context 1
... were placed through the abdominal wall. The first trocar was placed into the umbilicus for the laparoscope. After making a pneumoperitoneum, the next two trocars were placed into the right and left middle abdomen for the operator. Laparoscopic findings showed the right indirect inguinal hernia and the hernia orifice was 2 cm sized in diameter (Fig. 3). Pulling the hernial sac back to the abdominal cavity, we could find out the intracanalicular testis along with a spermatic cord and a testicular vessels, then they were cut and ligated (Fig. 4). The testis was extracted through the umbilical port site, after the incision was extended to 2 cm. Next to laparoscopic right orchiectomy, ...
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Introduction:
The laparoscopic inguinal hernia repair in children using the PIRS technique is a well-established method. However, there are still opinions that this method does not bring more benefits than open surgery.
Purpose:
The study aims to demonstrate the benefits of laparoscopic technique over conventional, open techniques.
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Citations
... The TAPP technique allows a direct visualization of intra-abdominal structures that could not be visualized by CT. There have been only 12 reports of laparoscopic hernia repair for inguinal hernias with cryptorchidism in adults, including this case, and 10 reports of TAPP, including this case [6][7][8][9][10][11][12][13][14]. The most common reason for detection of cryptorchidism was the inability to palpate the testicles, suggesting the importance of a detailed physical examination of inguinal hernia patients, including palpation of the testicles. ...
Pediatric health checkups have been mandatory for all citizens since 1966 based on the Maternal and Child Health Law in Japan, and cryptorchidism or undescended testis in adult males are rare. We report a case of an adult right inguinal hernia and cryptorchidism treated simultaneously with laparoscopic transabdominal preperitoneal repair and laparoscopic orchiectomy. A 35-year-old man came to our department with a chief complaint of bulging in the right inguinal region for several months. He was diagnosed with a right inguinal hernia and was scheduled for transabdominal preperitoneal repair. During intraoperative intraperitoneal observation, a white 30-mm mass was found in the hernia orifice. A diagnosis of right cryptorchidism was made, and transabdominal preperitoneal repair and laparoscopic orchiectomy were performed. Laparoscopic simultaneous surgery could be safely performed in an adult patient with a hernia complicated by a cryptorchidism. It can be recommended as a surgical option in such cases.
... Cryptorchidism is usually diagnosed and treated in childhood, and adult patients with cryptorchidism are relatively rare. Current literature reports on treating cryptorchidism in adults are scarce, and most are case reports [3][4][5][6]. In this study, we investigated the safety and efficacy of laparoscopic orchidopexy for the treatment of cryptorchidism in adults to highlight the technique and outcomes. ...
... This retrospective study was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University. The inclusion criteria for this study were as follows: [1] adult males, [2] patients with unilateral/ bilateral cryptorchidism, and [3] patients with a strong desire to procreate or a strong desire for testicular preservation. The exclusion criteria in this study were as follows: [1] significant testicular atrophy revealed through laparoscopic exploration; [2] undescended testes with evidence of deterioration; [3] comorbid severe cardiovascular disease, diabetes mellitus, liver dysfunction, renal disease, and severe hematological disorders; and [4] contraindications to general anesthesia. ...
... The inclusion criteria for this study were as follows: [1] adult males, [2] patients with unilateral/ bilateral cryptorchidism, and [3] patients with a strong desire to procreate or a strong desire for testicular preservation. The exclusion criteria in this study were as follows: [1] significant testicular atrophy revealed through laparoscopic exploration; [2] undescended testes with evidence of deterioration; [3] comorbid severe cardiovascular disease, diabetes mellitus, liver dysfunction, renal disease, and severe hematological disorders; and [4] contraindications to general anesthesia. We identified 37 adult cryptorchidism patients aged 30.92 ± 9.1 years between November 2017 and February 2022 (Table 1). ...
Background
There are few studies on cryptorchidism in adults, and its treatment is still controversial.
Methods
To summarize the surgical strategy and clinical efficacy of laparoscopic orchidopexy for the treatment of cryptorchidism in adults, 37 adult cryptorchidism patients were retrospectively analyzed between September 2017 and February 2022. All 37 patients underwent laparoscopic orchidopexy, of whom 33 underwent inguinal hernia repair without tension. The intraoperative procedures and surgical techniques were recorded in detail. Preoperative examination and regular postoperative review of color Doppler ultrasound, and reproductive hormone, alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase levels were performed.
Results
All testes descended successfully into the scrotum, including 25 through the inguinal route and 12 through Hesselbach’s triangle route. No intraoperative or postoperative complications were observed. The follow-up time was 38.6 (± 19.4) months, and no evidence of testicular malignancy was found during the follow-up period. After analyzing the reproductive hormone levels at 1 year postoperatively in 28 patients with more than 1 year of follow-up, it was found that the patients had a significant increase in testosterone levels and a decrease in follicle-stimulating hormone levels after surgery. None of the patients showed any significant improvement in semen quality after surgery.
Conclusion
Our study suggests that laparoscopic orchidopexy is a safe and feasible surgical procedure for the treatment of cryptorchidism in adults, especially high cryptorchidism, which is difficult to treat. After comprehensive consideration, preserving the testis should be preferred for treating cryptorchidism in adults to maximize the protection of the patient’s reproductive hormone secretion function.
An 82-year-old man with a history of surgery for a right-sided thoracic deformity and hand malformation during infancy was referred to our hospital after reduction of an incarcerated right inguinal hernia at another hospital. Computed tomography revealed a right inguinal hernia and bowel obstruction. The right scrotum did not contain the testis, and a hernia sac and a mass that appeared to be the testis were identified in the subcutaneous tissue. Additionally, we observed a right rib cage deformity, abnormal bone in the right chest, one kidney, and intestinal malrotation. He was diagnosed with a right inguinal hernia, right cryptorchidism, and Poland syndrome. Intraoperatively, the hernia sac did not reach the scrotum but extended in the cranial and lateral directions after it passed through the external inguinal ring and merged with the subcutaneous tissue on the ventral aspect of the external oblique muscle aponeurosis. We performed hernia repair and orchiectomy. Cryptorchidism is a common congenital abnormality in males ; however, it is rarely observed in adults because most patients undergo surgical treatment at approximately 1-2 years of age. An inguinal hernia associated with cryptorchidism is rare in adults, and its association with Poland syndrome (a rare congenital anomaly) is even rarer.
A 70-year-old man was admitted to our hospital for a lump in the left groin. Physical examination showed an egg-sized lump in the left inguinal region. The lump was easily reducible in the supine position, and the patient was diagnosed with a left inguinal hernia. Palpation showed absence of the left testis in the scrotum. Computed tomography revealed prolapse of the sigmoid colon into the hernia sac and a soft tissue shadow at the neck of the sac. Following consultation with the urology department and based on the patient's history of a scrotal injury secondary to a vehicular accident, this shadow was attributed to traumatic testicular dislocation. Dislocated testes may undergo malignant transformation. Therefore, we performed laparoscopic left inguinal hernia repair concomitant with left orchiectomy. Intraoperatively, the soft tissue mass could not be accurately identified as the testis owing to atrophy. Histopathological evaluation of the resected specimen revealed no evidence of testicular malignancy. This is the first Japanese case report that describes an inguinal hernia complicated by traumatic testicular dislocation. We emphasize that careful scrotal palpation is important to confirm the presence of the bilateral testes in the scrotal sac in patients who undergo physical examination for evaluation of inguinal hernia, to avoid missing the diagnosis of testicular dislocation.
