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Secondarily ascended testes following inguinal surgery: An under recognized and preventable complication?
Madeline Cancian, MD1, Pamela Ellsworth, MD2, Anthony Caldamone, MD1.
1Brown University, Pawtucket, RI, USA, 2University of Massachusetts, Worcester, MA, USA.

Background: Secondarily ascended testes occurs in up to 1.3% of cases following previous inguinal surgery. This has generally been attributed to scarring in the inguinal area, however, has not be investigated in detail. As such, we hypothesis that this scarring is the major cause of secondarily ascended testis.
Methods: By database query 1607 inguinal orchiopexies were identified which were performed at our institution between 1/1997 to 12/2015. We included all procedures done for the indication of undescended testes (UDT). Excluding all orchiopexies which were first or second stage Fowler-Stephens or contralateral orchiopexies in the finding of a testicular nubbin, 1399 unilateral orchidopexies were identified and operative notes were reviewed to determine (1) presence and location of inguinal scarring, (2) position of previously ligated hernia sac, and (3) presence and patency of processus vaginalis.
Results: We identified 88 orchidopexies performed for a secondarily ascended testis following inguinal surgery, 6.3% of the total. The median age at primary inguinal surgery was 11.5 months. The average time between initial surgery and orchidopexy was 5.1 years. Scarring of the spermatic cord, primarily at the external ring and inguinal canal, was noted in 80% of ochiopexies. 12.5% of cases required further proximal dissection to free a previously ligated hernia sac, and 26% had an intact processus vaginalis.
Conclusions: Our results indicate that scarring is the major cause of secondarily ascended testes, however, a distal ligation of the hernia sac or incomplete dissection of the processus vaginalis may also contribute to secondary ascent of testes following inguinal surgery. Thus it is essential to determine the status of the processus vaginalis, regardless of the documentation of the previous operative note. Moreover, secondary ascension occurs on average 5 years after initial surgery. This latency period far exceeds the follow up time for studies documenting complications following inguinal surgery. As such, secondary ascent is likely more common than reported in the literature.


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