Redo Orchiopexy: When and How Is Repeat Surgery Performed?

Redo orchiopexy comes up in three situations: the testicle that was brought down to the scrotum retracting back toward the groin or the upper scrotum; the testicle having been brought down at the first surgery only under tension or only partially; and an unexpected need for a repeat procedure outside the planned second stage of a staged technique.

At the first surgery, tissue layers are separated along their natural planes; in a redo procedure, the inguinal canal, the cord, and the testicle are stuck together by scar tissue, and the usual anatomical landmarks are obscured.

Planning begins with the notes from the first surgery: the testicle's position at that time, the technique used, whether the hernia sac was closed, and any difficulties encountered. If this information is not available, the examination and history are relied on instead.

• Starting from the previous incision and healthy tissue
• Mobilizing the testicle and cord as a block together with the scar tissue
• Freeing the cord further up toward the abdomen; creating a shorter path if needed
• Placing and fixing the testicle tension-free in a new pocket in the scrotum
• Laparoscopic assistance if needed

Success in redo orchiopexy — the testicle remaining in the scrotum at a good size — is reported in the literature to be close to that of first-time surgery, though somewhat lower; the risk of atrophy is higher than at the first surgery because of the scar tissue, and it increases the higher the testicle sits.

Postoperative care is the same as after the first orchiopexy: outpatient surgery or an overnight stay, simple pain medication, a few days of wound care, and 2–4 weeks of activity restriction.