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by Neff DM

Orchiopexy—Open Surgery

(Orchidopexy—Open Surgery)

Definition

Sometimes baby boys are born with 1 or both testicles inside the abdomen or groin, rather than in the scrotum. This is called undescended testicles . Orchiopexy is a surgery to lower the testicles into the scrotum. The scrotum is the external sac that holds the testicles.
Undescended testes
IMAGE
© 2009 Nucleus Medical Media, Inc.

Reasons for Procedure

The procedure is used to treat undescended testicles that do not move down on their own.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your child's doctor will review potential problems, like:
  • Testicle moves back up into groin again after surgery
  • Damage to or loss of the testicle
  • Bleeding
  • Infection
  • Reaction to anesthesia
  • Injury to surrounding structures

What to Expect

Prior to Procedure

Your child’s doctor and anesthesiologist will do the following:
  • Examine your child
  • Do imaging, blood, and urine tests
  • Discuss the anesthesia being used and the potential risks
  • Discuss the risks of surgery and answer any questions you have
Talk to the doctor about your child’s medications or any recent illnesses. You may be asked to have your child stop or start certain medications before surgery.
Other things to keep in mind before the procedure include:
  • Bring special toys, books, and comfortable clothing for your child.
  • Your child will need to avoid eating for a period of time before surgery. Ask the doctor when your child should stop eating and drinking. For children less than 1 year, it is often recommended that they do not eat after midnight the night before the surgery. Clear liquids such as breast milk, water, and clear juices may be allowed up to 2 hours before the procedure.

Anesthesia

General anesthesia will be used. Your child will be asleep during the surgery.

Description of the Procedure

After your child is asleep, the doctor will make a small incision in 1 or both sides of the groin. The testicle is located and examined. If there is a hernia present, the doctor will also repair this.
Next, the doctor will create a pouch in the scrotum. The testicle will be pulled down into this new pouch. Permanent stitches will hold the testicles in place. All other incisions will be closed with stitches. The stitches will dissolve on their own.
In some cases, a small button will be placed on the outside of the scrotum and secured with a suture. This will hold the testicle down until healing occurs. The button will be removed by cutting the suture a few weeks after the procedure.
In most cases, your child can go home on the same day as the surgery.

How Long Will It Take?

1 hour per testicle

How Much Will It Hurt?

Anesthesia prevents pain during surgery. Your child will be given medication to relieve pain or soreness during recovery.

Post-procedure Care

At the Care Center
  • Your child will be monitored while recovering from the anesthesia.
  • Your child will be given pain medications as needed.
Preventing Infection
During your child's stay, the care center staff will also take steps to reduce the chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your child's incisions covered
There are also steps you can take to reduce your child's chance of infection, such as:
  • Washing both you and your child's hands often, and reminding visitors and healthcare providers to do the same
  • Reminding your child's healthcare providers to wear gloves or masks
  • Not allowing others to touch your child's incision
At Home
When your child returns home, you may need to do the following to help ensure a smooth recovery:
  • Engage in gentle play. Avoid tiring activities for a few weeks. Sitting on or riding a bicycle or other toys that require straddling should be avoided for about a week after the surgery.
  • Follow your the doctor's instructions.

Call Your Child’s Doctor

It is important to monitor your child's recovery. Alert your child's doctor to any problems. If any of the following occur, call your child's doctor:
  • Increasing pressure or pain
  • Redness, drainage, puffiness, or soreness around the incision site
  • Changes in the frequency, odor, appearance, or volume of urine
  • Difficulty urinating
  • Signs of infection, including fever or chills
  • Persistent nausea and/or vomiting
  • Abdominal pain
  • Lack of energy
  • Loss of appetite
If you think your child has an emergency, call for emergency medical services right away.

RESOURCES

Family Doctor—American Academy of Family Physicians
http://familydoctor.org
Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

CANADIAN RESOURCES

Caring for Kids—Canadian Pediatric Society
http://www.caringforkids.cps.ca
Health Canada
http://www.hc-sc.gc.ca

References

Elyas R, Guerra LA, Pike J, et al. Is staging beneficial for Fowler-Stephens orchiopexy? A systematic review. J Urol. 2010;183(5):2012-2018.
Orchiopexy: Surgery for undescended testicles. About Kids Health website. Available at: http://www.aboutkidshealth.ca/En/HealthAZ/TestsAndTreatments/Procedures/Pages/Orchidopexy-Surgery-for-Undescended-Testicles.aspx. Updated November 10, 2009. Accessed June 1, 2016.
Orchiopexy discharge instructions. Children’s Hospital and Clinics of Minnesota website. Available at: http://www.childrensmn.org/Manuals/PFS/Surg/018757.pdf. Updated October 2013. Accessed June 1, 2016.
Undescended testicles. Children’s Hospital of Philadelphia website. Available at: http://www.chop.edu/treatments/surgery-undescended-testicles-orchiopexy#.VZBqk010xMs. Accessed June 1, 2016.

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