PubMed · 4386629
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I D Macleod. 1968. Cryptorchidism.. https://pubmed.ncbi.nlm.nih.gov/4386629/
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PURPOSE: In 1975 the clinical importance of the preperitoneal fascial or secondary internal ring was noted based on procedures performed through the suprainguinal preperitoneal approach. The importance of knowledge of the secondary internal ring in the performance of inguinal hernia repairs, orchiopexies and operations for impalpable testes through the inguinal canal is shown, along with a description of the anatomy of the internal ring and subjacent retroperitoneal connective tissue. MATERIALS AND METHODS: More than 250 consecutive inguinal canal dissections were performed during surgery for inguinal hernia repair, orchiopexy or impalpable testes by a single surgeon using 3.5x magnification. RESULTS: The intraoperative dissections clearly showed the existence of a secondary internal ring, which when opened provided wide access to the retroperitoneal space containing the internal spermatic vessels and vas deferens. CONCLUSIONS: Knowledge of the anatomy of the secondary internal ring is an adjunct to the performance of operations through the inguinal canal.
A 1-year-old boy with prune-belly syndrome underwent unilateral laparoscopic clip ligation of the spermatic vessels with the hope of developing vasal collateral circulation. Six months later, the patient underwent ipsilateral second-stage orchiopexy on the right testis after division if the ligated spermatic vessels and contralateral Fowler-Stephens orchiopexy on the left testis in combination with major urinary tract reconstructions and abdominoplasty. For the following 1-year period, both testes were growing and comparable in size.
The management of the testicles in the prune belly syndrome can be problematic after the neonatal period. Laparoscopic orchidopexy has been used for the intra-abdominal testis with success. A case of bilateral laparoscopic orchidopexy in a child with prune belly syndrome is presented. The testes were brought to the scrotum without division of the spermatic vessels, taking advantage of the extensive intra-abdominal dissection possible laparoscopically. This case demonstrates that therapeutic laparoscopic procedures are possible in the prune belly syndrome and that laparoscopic orchidopexy may have promise in older affected children or in those requiring no other concomitant surgery.