Comparative Outcomes of Single-Stage versus Two-Stage Laparoscopic Fowler-Stephens Orchidopexy: A Systematic Review snd Meta-Analysis.

IF 1.5 3区 医学 Q2 PEDIATRICS European Journal of Pediatric Surgery Pub Date : 2024-08-22 DOI:10.1055/a-2375-9784
Adrian Chi Heng Fung, Jaime Tze Wing Tsang, Ling Leung, Ivy Hau Yee Chan, Kenneth Kak Yuen Wong
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Abstract

Introduction:  Intra-abdominal testis (IAT) remains a challenging and controversial subset within the management of cryptorchidism. While Fowler-Stephens orchidopexy (FSO) is still being advocated as the gold standard for the treatment of this entity, there is new and conflicting evidence on the comparative outcomes between single- or two-stage laparoscopic FSO (LFSO). The aim of the study is to investigate whether staging has benefits in children receiving LFSO.

Methods:  We searched the PubMed, Medline, Embase, and Cochrane Trials databases for studies comparing single- with two-stage LFSO in children from January 1, 1995 to December 31, 2023. We assessed the identified studies for quality and performed a systematic review and meta-analysis in accordance with the Preferred Reporting of Systematic Reviews and Meta-Analyses. The main outcome measures examined were success rate (in terms of the scrotal position of the testis) and testicular atrophy, which were analyzed using fixed effect models.

Results:  We included 17 eligible studies that involved a total of 499 operated testes. The overall success rates of single- and two-stage LFSO were 79.4 and 90.3%, respectively. The overall testicular atrophy rates of single- and two-stage LFSO were 17.3 and 11%, respectively. Fixed effect model analysis showed that two-stage LFSO is significantly superior to single-stage LFSO in overall success rate (odds ratio [OR: 2.57]; 95% confidence interval [CI]: 1.50-4.39, p = 0.0006) and testicular atrophy rate (OR: 0.48; 95% CI: 0.28-0.79, p = 0.004). There is no heterogeneity in the reports, and the funnel plot showed no publication bias.

Conclusions:  Two-stage LFSO remains the first choice of operation for children with a high IAT, with a significantly higher success rate and a lower testicular atrophy rate.

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单段式与两段式腹腔镜 Fowler-Stephens 输卵管整形术的疗效比较:系统回顾与元分析》。
导言:腹腔内睾丸(IAT)仍然是隐睾症治疗中一个具有挑战性和争议性的子集。尽管福勒-斯蒂芬斯睾丸切除术(FSO)仍被认为是治疗这种疾病的金标准,但关于单级或两级腹腔镜睾丸切除术(LFSO)的比较结果,目前仍有新的相互矛盾的证据。本研究旨在探讨分期对接受 LFSO 的儿童是否有益。方法 我们在 PubMed、Medline、Embase 和 Cochrane 试验数据库中检索了 1995 年 1 月 1 日至 2023 年 12 月 31 日期间比较儿童单期和两期 LFSO 的研究。我们对已确定的研究进行了质量评估,并根据《系统综述和荟萃分析的首选报告方法》(Preferred Reporting of Systematic Reviews and Meta-Analyses,PRISMA)进行了系统综述和荟萃分析。研究的主要结果指标是成功率(睾丸阴囊位置)和睾丸萎缩,采用固定效应模型进行分析。结果 我们纳入了 17 项符合条件的研究,共涉及 499 例睾丸手术。单级和两级 LFSO 的总体成功率分别为 79.4% 和 90.3%。单期和两期 LFSO 的睾丸萎缩率分别为 17.3% 和 11%。固定效应模型分析显示,在总体成功率(几率比 [OR 2.57]; 95% 置信区间 [CI] 1.50-4.39,P = 0.0006)和睾丸萎缩率(OR 0.48; 95% CI 0.28-0.79,P = 0.004)方面,两阶段 LFSO 明显优于单阶段 LFSO。报告中不存在异质性,漏斗图显示无发表偏倚。结论 两期 LFSO 依然是 IAT 高的儿童的首选手术,其成功率明显更高,睾丸萎缩率更低。
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来源期刊
CiteScore
3.90
自引率
5.60%
发文量
66
审稿时长
6-12 weeks
期刊介绍: This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.
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