Shehata Traction Technique: A Vessel-Preserving Staged Orchiopexy

For a high intra-abdominal testicle, the problem is vessel length. The Fowler–Stephens approach solves this by dividing the main vessel and relying on collateral circulation; the Shehata technique, by contrast, preserves the vessel and aims to lengthen it through gradual tension.

The first session is performed under the same anesthesia, as a continuation of the diagnostic laparoscopy. Once the testicle is seen to be high and the vessels are found not to reach the scrotum, the plan already discussed with the family is put into action.

• The testicle is freed from the surrounding peritoneum while its vessels and vas deferens are preserved; the gubernaculum (guiding ligament) attachment is divided.
• The testicle is moved within the abdomen to the opposite side, to a point on the inner surface of the anterior abdominal wall above and across from the navel, and is anchored there with a stitch so that its vessels are held under gentle tension.
• The color and blood supply of the testicle are checked; if the tension is excessive, the anchor point is adjusted.
• The ports are closed; the procedure usually takes 45–60 minutes, and the child goes home the same day or the following day.

• In this session, the testicle is not brought down into the scrotum; mild abdominal pain in the first days is normal. In our practice, this operation is performed jointly by two pediatric urology specialists; the anchor point and the amount of tension are set through their joint assessment.

Between the two sessions, a wait of about 12 weeks is observed; this is the period during which the initial studies observed the vessels to reach sufficient length. The child continues normal life during this time; no special medication or restrictions are needed.

• During this interval, the stitch coming loose and the testicle slipping back to its earlier position has rarely been reported; this is noticed at the second laparoscopy, and the plan is revised accordingly. If anything out of the ordinary occurs, such as fever, abdominal pain, or redness at the port sites, the physician should be contacted.

The second session again begins laparoscopically.

• The testicle is released from the anchor point on the abdominal wall; the length of the vessels and the viability of the testicle are assessed.
• With the vessels preserved, the testicle is routed through a short path medial to the inferior epigastric vessels, leading directly to the scrotum.
• A subdartos pocket is created in the scrotum; the testicle is placed without tension, and the ports are closed.

• The second session may take 45–90 minutes; the child goes home the same day or the following morning. Swelling and mild bruising in the scrotum are expected in the first days; pain resolves with simple pain relievers. If the vessels still do not reach, the same session can be converted to the Fowler–Stephens approach; although this possibility is uncommon, it is discussed beforehand.

The main advantage of the technique is preservation of the main testicular vessel; in theory, this reduces the risk of atrophy, and the initial case series and small comparative studies have reported high testicular survival rates. The interval between the two sessions is shorter than with Fowler–Stephens.