Transparenchymal testicular suture: A systematic review and meta-analysis highlighting the impact of additional fixation suture during routine orchiopexy

Abstract

Background: Orchiopexy for cryptorchidism is one of the common day-care surgeries performed by pediatric surgeons across the globe. Although majority of the surgeons reposition the testis into a sub-dartos pouch, the practice of taking an additional transparenchymal anchoring suture is often debated. The potential risks include impaired spermatogenesis and sub-fertility. Also, a consensus statement regarding the superiority of suture fixation over no suture fixation, in terms of prevention of recurrence of cryptorchidism, is lacking. This systematic review and meta-analysis aims to compare the outcomes of orchiopexy between the two groups i.e. without (Group A) and with the transparenchymal suture fixation (Group B).

Method: The authors systematically searched the databases PubMed, EMBASE, Web of Science and Scopus through October, 2020 for comparative studies. Statistical analysis was performed using a fixed-effects model; and pooled risk ratio (RR) and heterogeneity (I²) were calculated. The methodological quality of the studies was assessed utilizing the Downs and Black scale.

Result: Five comparative studies, comprising a total of 734 and 1002 children within the groups A and B respectively, were recruited in this study. As compared to the children belonging to group A, a significantly higher incidence of recurrence of cryptorchidism (RR 1.75; 95% CI 1.10-2.80, p = 0.02) was observed among the children of group B. However, the difference in the incidence of testicular atrophy could not reach statistical significance (RR 1.56; 95% CI 0.23-10.50, p = 0.65). The average Downs and Black scale scores ranged from 15 to 21.5, with all the studies having moderate to high-risk of bias.

Conclusion: The present meta-analysis revealed superiority of orchiopexy performed without transparenchymal suture fixation in terms of recurrence of cryptorchidism. Although, the incidence of testicular atrophy was higher among the children belonging to the suture group, no statistically significant difference was observed among the two groups. However, the level of evidence of the published comparative studies is limited. Therefore, it is recommended to focus on adequate mobilization of the testis and its positioning in the sub-dartos with minimal tension rather than over-reliance on futile adjuncts like taking transparenchymal testicular suture.

Keywords: Cryptorchidism; Orchiopexy; Suture fixation; Testicular atrophy; Transparenchymal.