Management of the high intra-abdominal testis is a challenging surgical procedure. Most pediatric urologists today would advocate either a laparoscopic or transabdominal orchiopexy to keep the gonadal vessels intact, but in some patients the testicular artery will be too short and not amenable to a standard orchiopexy. Preservation of these testicles requires either a microvascular procedure, in which the testicular vessels are reanastomosed to larger vessels in the leg, or a staged procedure, in which the vessels are ligated in the first operation, and the testicle is mobilized on a wide strip of peritoneum and moved to the scrotum on the basis of the blood supply of the vas deferens. Recognition of the patients who will require a 2-stage Fowler-Stephens procedure early in the initial exploration is probably one of the most important aspects of achieving a good outcome. Early recognition allows the avoidance of manipulation and possible injury of the collateral blood supply of the vas deferens and peritoneum that is necessary for a successful second-stage procedure. A prior meta-analysis of the previously reported 2-stage Fowler-Stephens procedures found an overall success rate of only 69%. The study authors review their success with a 2-stage Fowler-Stephens procedure.
http://www.medscape.com/viewarticle/501229
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