Comparison of Outcome of Sac Ligation versus No Sac Ligation in Pediatric Patients Undergoing Inguinal Orchidopexy for Incompletely Descended Palpable Testes: A Randomized Controlled Trial

Abstract

Abstract
Background and Objective: The case of undescended Testis (UDT) is one of the most common condition
presented to a pediatric surgeon. The standard procedure to rectify UDT is known as Orchidopexy. The main
objective of this study is to examine and compare the results of orchidopexy surgeries conducted with or
without sac ligation in palpable undescended testis of pediatric patients.
Methods: This randomized controlled trial was done over a period of 12 months (July 2018 to July 2019) at
the Department of Pediatric Surgery, Children's Hospital & Institute of Child Health, Lahore. The selection of
cases was made dependent upon fulfillment of departmental criteria and approval by ethical review
committee. Consequently, 280 cases divided into two equal groups i.e. Group-A and Group-B (140 cases in
each group) were shortlisted for the study after detailed scrutiny. The allotment of patient to above mentioned
groups was randomized by lottery method. The patients in Group-Aunderwent orchidopexy with ligation of
sac while the patients of Group-B were operated without sac ligated. The surgeries were performed under
general anesthesia by consultant surgeons of same caliber and competence. Moreover, in order to quantify
and analyze the results of surgeries parameters such as Mean Operative Time, Postoperative Manifestations
and recurrence of UDT were recorded on proforma. Subsequently, SPSS version 25 statistical software was
utilized for calculating the mean and standard deviation of numerical variables such as age and operative
time. Additionally, the frequency and percentage of variables such as recurrent UDT were also calculated.
Chi-square test was applied to recurrent UDT and development of inguinal hernia. It is highlighted that Pvalue ≤0.05 was taken as significant.
Results: Among 140 patients of sac ligation group, 40.7% were 1-4 years old and among 140 patients of no
sac ligation group, 42.9% were 1-4 years old. In sac ligation group, 60.0% patients had right undescended
testis while in no sac ligation group, 67.1% patients had right undescended testis. In sac ligation group, the
mean operative time was 37.81 + 8.82 minutes while in non-sac ligation group; the mean operative time was
24.34 + 4.12 minutes. In sac ligation group, no patient had post-operative hernia while in non-sac ligation
group, 1.4% patients had post-operative hernia (p=0.15). In sac ligation group, 1.4% patients had recurrent
UDTwhile in non-sac ligation group, 2.1% patients had recurrence. (p= 0.65)
Conclusion: Study concluded that non-sac ligation technique is more effective than sac ligation technique in
terms of operative time and should be preferred for patients by surgeons.
Keywords: Orchidopexy, undescended testes, testicular atrophy, inguinal hernia, recurrence.