Orchiopexy, abdominal approach, for intra-abdominal testis (eg, Fowler-Stephens)
CPT4 code
Name of the Procedure:
Orchiopexy, Abdominal Approach for Intra-Abdominal Testis (e.g., Fowler-Stephens Technique)
Summary
Orchiopexy using the abdominal approach is a surgical procedure to reposition an undescended testis (testicle) that is located in the abdomen. The Fowler-Stephens technique, often part of this procedure, involves clipping and dividing the blood vessels of the testis to allow it to move to the scrotum with minimal tension on the vessels.
Purpose
This procedure addresses the condition of an undescended testis (cryptorchidism), typically in young males. The goals are to place the testis in the scrotum to improve fertility, reduce the risk of testicular cancer, and enhance physical appearance and psychological well-being.
Indications
- An undescended testis identified on physical examination or imaging studies
- Failures of hormone therapy to induce testicular descent
- Presence of an intra-abdominal testis as confirmed by diagnostic imaging or laparoscopy
Preparation
- Patients are often required to fast for 6-8 hours before anesthesia.
- Preoperative blood tests, including complete blood count (CBC) and coagulation profile, may be required.
- Imaging studies, such as ultrasound or MRI, to locate the testis.
- Discussion of any medications to be adjusted or halted, particularly blood thinners.
Procedure Description
- The patient is given general anesthesia.
- A small incision is made in the abdomen, and laparoscopic instruments are inserted for visualization and maneuvering.
- The Fowler-Stephens technique may involve clipping and dividing the testicular vessels to allow the testis to be mobilized.
- The testis is carefully moved through the abdominal cavity and into the scrotum.
- The testis is secured in the scrotum using sutures.
- The incisions are closed, and sterile dressings are applied.
Duration
The procedure typically takes 1 to 3 hours, depending on the complexity and whether one or both testes need to be repositioned.
Setting
This procedure is usually performed in a hospital operating room or a surgical center equipped for advanced laparoscopic surgeries.
Personnel
- Pediatric or urologic surgeon
- Surgical nurses or assistants
- Anesthesiologist
- Operating room technicians
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Damage to surrounding organs or tissues
- Testicular atrophy (shrinkage) due to disruption of blood supply
- Recurrence of the undescended testis
Benefits
- Improved fertility potential
- Reduced risk of testicular cancer
- Enhanced physical appearance of the scrotum
- Alleviation of psychological distress from undescended testis
Recovery
- Patients are monitored in the recovery room for a few hours post-surgery.
- Postoperative care includes pain management, typically with over-the-counter painkillers or prescribed medications.
- Instructions to avoid strenuous activities for a few weeks.
- Follow-up appointments to check the healing process and the position of the testis.
- Most children can return to normal activities within a few weeks.
Alternatives
- Hormone therapy (less effective for intra-abdominal testis)
- Watchful waiting, though this carries risks such as infertility and increased cancer risk
- Observation and repeated imaging, especially in uncertain cases
Patient Experience
- Anxiety before the procedure; reassurance and support from the healthcare team are essential.
- The patient will be under general anesthesia, so no pain will be felt during the surgery.
- Postoperative discomfort managed with pain medicines.
- Temporary soreness at the incision sites and reduced activity level for a few days.
Adequate preparation and understanding of the procedure can help ensure a smoother experience and recovery for the patient.