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Archives de pédiatrie
Volume 11, n° 4
pages 315-318 (avril 2004)
Doi : 10.1016/j.arcped.2004.01.010
Received : 12 September 2003 ;  accepted : 2 January 2004
Testicules impalpables. Place de la coelioscopie
Laparoscopic surgery for undescended testicles

M.  Stéfaniu,  B.  Lefébure,  A.  Liard-Zmuda,  B.  Bachy *
Clinique chirurgicale infantile, CHU de Rouen, hôpital Charles-Nicolle, 1, rue Germont, 76031 Rouen cedex, France 

*Auteur correspondant.
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Objectif.- La prise en charge des testicules impalpables (cryptorchidies) est une préoccupation habituelle des équipes spécialisées de chirurgie pédiatrique. L'exploration coelioscopique première est maintenant admise par la plupart des auteurs mais l'attitude thérapeutique et les techniques d'abaissement restent discutées. Le clampage premier du pédicule spermatique dans le temps de l'exploration permet le développement de suppléances garant d'une bonne vascularisation de la gonade lors de l'abaissement définitif quelques mois plus tard.

Matériel et méthode. - Une série de 122 garçons porteurs d'une cryptorchidie a été revue. Tous ces enfants ont eu une coelioscopie exploratrice. Lorsque le testicule était retrouvé, un clampage du pédicule spermatique a été effectué dans le même temps et l'abaissement définitif a été réalisé quelques mois plus tard.

Résultats. - Une gonade a été retrouvée dans 60 cas et le clampage du pédicule spermatique dans le même temps a permis un abaissement satisfaisant quatre à six mois plus tard dans près de 80% des cas.

Conclusion. - L'étude de cette série rétrospective du clampage premier par voie coelioscopique des testicules impalpaples confirme une meilleure fiabilité de cette technique comparée aux abaissements en un temps.

Mots clés  : Testicules ; Cryptorchidie ; Coelioscopie.

Abstract

Purpose. - Impalpable and undescended testis is a very common preoccupation for specialized pediatric surgery teams. The laparoscopy as the single most accurate modality for diagnosis and localization of impalpable undescended gonad is well established by all authors. However the therapeutic attitude and the technique are still a matter of debate.

Material and methods. - A series of 122 boys presenting an impalpable and undescended testis was studied. All the children beneficiated of a primary laparoscopic exploration. During this exploration, when a testis was found, the clamping of the spermatic vessel was made and the final descent took place few months later.

Results. - In our study the testis was found in 60 cases and the spermatic vessel's clamping assured the descent of a well vascularized testis in about 80% of cases.

Conclusion. - Clamping the spermatic vessel during the laparoscopic exploration assured, thanks to the development of a supply, a good vascularisation of the testis during its second step descent. Our retrospective study has showed the good reliability of laparoscopic surgery as primary treatment in front of impalpable undescended testicles in comparison to the one-step classical orchiopexy.

Mots clés  : Cryptorchidism ; Surgical procedures, laparoscopic ; Child.




© 2003  Published by Elsevier Masson SAS.

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