Login to Access Video or Poster Abstract: MP66-16
Sources of Funding: None

Introduction

The 2014 American Urologic Association cryptorchidism guidelines recommend abdominal orchiopexy for testes remaining non-palpable when examined under anesthesia after 6 months of age. Laparoscopic and open approaches are considered equivalent and dependent upon surgeon preference. We questioned whether immediate post-operative complications were comparable.

Methods

The American College of Surgeons National Surgical Quality Improvement Program data file was queried for laparoscopic (lap) and open orchiopexies of abdominal testes from 2012 - 2014. Data points included: age, ASA class, surgeon type, length of stay, operative time, complications, reoperation, and readmission. Statistical analyses included Student&[prime]s t-test and chi-square.

Results

A total of 1039 lap and 489 open abdominal orchiopexies were performed. Lap orchiopexy was performed even more commonly in 2013 (p=0.018) and 2014 (p<0.001) than in 2012. There was no difference in ASA class between approaches. Pediatric urology performed the most orchiopexies (822 lap, 414 open), followed by pediatric surgery (126 lap, 52 open). Urology (63 lap, 19 open) and general surgery (23 lap, 0 open) performed fewer procedures. There was no difference in approach among the pediatric subspecialists (p=0.294). Patients undergoing the lap approach were younger (mean 919.8±34.9 vs 1266.0±62.5 days, p<0.001). There was a trend towards lap surgeries being more commonly performed as outpatient (94.3% vs 91.2%, p=0.08). The mean length of stay was shorter for lap patients (0.17±0.04 vs 0.48±0.20 days, p=0.035), however open surgeries were shorter (73.7±3.0 vs 85.9±1.6 minutes, p<0.001). While the complication rate was low for both approaches (presented in the table), they were more than twice as likely to occur with the open approach (p=0.03). There was no statistical difference in reoperation rate (0.3% lap vs 0.6% open) or readmission rate (1.2% lap vs 1.8% open).

Conclusions

Although the open approach to abdominal orchiopexy takes less time to perform, the length of stay is longer. Immediate post-operative complications occur more commonly with the open approach, however the rate is low for both. Population studies into long term outcomes, such as failure or testicular loss, may offer further insight as to whether one approach is superior to the other.

Funding

None