This video demonstrate Laparoscopic treatment for inguinal hernia combined with cryptorchidism management by Trans Abdominal Preperitoneal repair of hernia in a patient with undescended testes with hernia. Laparoscopic hernia repair with orchiectomy under the same operative view. Approximately 7% of child patients with inguinal hernias also present with cryptorchidism. On the other hand, combined adult cases are uncommon. Here we report two adult cases of inguinal hernia combined with intra-canalicular cryptorchidism who underwent TAPP repair with orchiodectomy under the same operative view. Laparoscopic hernia repair with orchiectomy under the same operative view could be safely performed in adults with an inguinal hernia combined with extra-abdominal cryptorchidism. This procedure could be an option for the treatment of such adult patients. Cryptorchidism is a condition in which one or both testes fail to descend into the scrotum before birth. The frequency of undescended testes has been reported as 4.1–6.9% during the neonatal period, 1.0–1.6% by 3 months of age, 1.0–1.7% by 1 year of age, and less than 1.0% after 1 year of age. Orchiectomy is also recommended for adult cases because adult patients with cryptorchidism already lack spermatogenic function and have a risk of neoplasms.

Laparoscopic surgery has transformed the field of urology and general surgery by offering minimally invasive solutions with faster recovery, less pain, and better cosmetic outcomes. One such advanced procedure is laparoscopic orchiectomy combined with hernia repair, which addresses both undescended or diseased testicles and concurrent inguinal hernias in a single surgical session.

What is Laparoscopic Orchiectomy?

Orchiectomy is the surgical removal of one or both testicles. Traditionally performed as an open surgery, it is now increasingly done laparoscopically, especially in cases of undescended testicles (cryptorchidism), testicular tumors, or hormone management in advanced prostate cancer.

Laparoscopic orchiectomy involves small incisions in the abdomen through which a camera and instruments are inserted. The surgeon can visualize the testicle and spermatic cord structures, allowing precise removal with minimal trauma.

Hernia Repair and Its Importance

An inguinal hernia occurs when abdominal contents protrude through the inguinal canal. It is common in men and can sometimes coexist with undescended or abnormal testicles. Repairing a hernia concurrently prevents complications like bowel obstruction, chronic pain, or recurrence.

Laparoscopic hernia repair techniques, such as TAPP (Transabdominal Preperitoneal) or TEP (Totally Extraperitoneal), involve placing a mesh over the hernia defect through small incisions, minimizing post-operative discomfort and speeding up recovery.

Benefits of Combining the Procedures

Performing laparoscopic orchiectomy and hernia repair together has several advantages:

1. Single Anesthesia: The patient undergoes only one anesthesia session, reducing risk.

2. Reduced Recovery Time: Minimally invasive approach allows faster mobilization and return to daily activities.

3. Lower Risk of Infection: Smaller incisions mean less exposure and reduced post-operative infections.

4. Cost-effective: Combining procedures reduces overall hospital stay and treatment costs.

5. Enhanced Visualization: Laparoscopy provides a magnified view of the inguinal region, ensuring precise dissection and mesh placement.

Surgical Technique Overview

1. Patient Preparation: The patient is placed under general anesthesia in a supine or slight Trendelenburg position.

2. Port Placement: Small incisions are made in the abdomen to insert a laparoscope and surgical instruments.

3. Orchiectomy: The affected testicle is identified, mobilized, and removed with careful ligation of the spermatic cord.

4. Hernia Repair: The hernia sac is reduced, and a mesh is placed to reinforce the inguinal canal. Depending on the case, TAPP or TEP technique is selected.

5. Closure: Ports are removed, and small incisions are closed with sutures or surgical glue.

Recovery and Post-Operative Care

Patients typically stay in the hospital for a short period (1–2 days). Recovery involves:

• Mild pain controlled with oral analgesics

• Avoidance of heavy lifting for 4–6 weeks

• Monitoring for swelling, bleeding, or infection

• Follow-up visits to assess wound healing and hernia repair success

Potential Risks

As with any surgery, risks exist but are minimal in laparoscopic approaches:

• Infection or bleeding

• Recurrence of hernia

• Injury to nearby structures

• Rare complications such as chronic pain

Conclusion

Laparoscopic orchiectomy combined with hernia repair represents a safe, effective, and minimally invasive solution for patients with testicular disorders and inguinal hernias. With the advantages of reduced pain, faster recovery, and precise surgical outcomes, this combined approach is increasingly becoming the preferred choice for urologists and general surgeons worldwide.