Laparoscopic one-stage vessel-sparing orchiopexy and two-stage laparoscopic Fowler-Stephens orchiopexy: a comparative study

Objective To compare the surgical outcomes of laparoscopic one-stage vessel-sparing orchiopexy (1S-LSO) and two-stage Fowler-Stephens laparoscopic orchiopexy (2S-LFSO) in the management of intra-abdominal undescended testes (IAUT) located less than 2.5 cm from the deep inguinal ring. Materials and methods A retrospective study was conducted on 75 intra-abdominal undescended testes (IAUT) in 65 pediatric patients who underwent laparoscopic orchiopexy between January 2021 and June 2024. Data collected included patient age, operative duration, perioperative complications, postoperative testicular position, and testicular volume. Outcomes were compared between the 1S-LSO group and 2S-LFSO group. Results The median age at surgery was 33 months (interquartile range: 17–74 months). 45 testes were managed with 1S-LSO and 30 with 2S-LFSO, with no intraoperative or early postoperative complications observed. The follow-up rate was 77.3% (58/75 testes), with a mean follow-up duration of 18.9 ± 7.1 months. The rate of successful scrotal placement was high in both groups: 78.8% for 1S-LSO and 88.0% for 2S-LFSO ( p = 0.32). Similarly, the rate of testicular atrophy was not significantly different: 3.0% for 1S-LSO and 8.0% for 2S-LFSO ( p = 0.57). The 1S-LSO group demonstrated a statistically significant increase in postoperative testicular volume (preoperative median volume 0.34 mL vs. postoperative volume 0.38 mL, p = 0.022), whereas no significant within-group change was observed in the 2S-LFSO group (0.35 mL vs. 0.33 mL, p = 0.653). Conclusions Both 1S-LSO and 2S-LFSO are safe and highly effective for the treatment of IAUT. Although success and atrophy rates did not differ significantly between groups, the significant increase in postoperative testicular volume observed only in the 1S-LSO group suggests a possible advantage in postoperative testicular growth during the observed follow-up period. The choice of technique should be guided by careful anatomical and intraoperative assessment, favoring the single-stage vessel-sparing procedure when conditions permit.