What Is Orchiopexy? Undescended Testicle Surgery Step by Step

Orchiopexy is the name for the operation in which an undescended testicle is freed from surrounding tissue, brought down into the scrotum, and fixed in place there; the word is built from two roots meaning “testicle” and “fixation.” Every operation performed for undescended testicle (cryptorchidism) shares this common goal: bringing the testicle into the scrotum and keeping it there permanently.

Whichever approach is used, the surgery proceeds in a set sequence. The steps below summarize the standard flow for a testicle palpable in the groin; the initial steps differ in laparoscopic and staged operations.

• Anesthesia: Performed under general anesthesia; at most centers, a regional block (caudal or nerve block) is added for pain control, so the child has little pain on waking.
• Incision: A 2–3 cm incision is made, hidden within a skin crease in the groin; if the testicle is close to the scrotum, a single incision can be made there instead.
• Freeing (mobilization): The testicle and spermatic cord (blood vessels and vas deferens) are separated from surrounding adhesions and from the gubernaculum, the guiding ligament. The goal is to give the cord enough length to reach the scrotum without tension.
• Hernia sac: The open peritoneal extension that descended along with the testicle (the hernia sac) is separated from the cord and closed. This step both gains additional length and prevents a hernia from forming later.
• Fixation in the scrotum: Through a small incision in the scrotal skin, a pocket is created between the skin and the underlying muscle layer (dartos); the testicle is placed into this subdartos pocket. It is usually held in place simply by the snugness of the pocket; a thin, dissolvable stitch is added if needed.
• Closure: The incisions are closed with dissolvable, subcuticular stitches; suture removal is generally not needed.

• Among these steps, the most decisive is freeing the tissue. To give the spermatic cord enough length, the vessels along the posterior abdominal wall are carefully traced and freed upward; because tension can compromise the testicle’s blood supply, it is never forced down.

For a unilateral, palpable testicle, surgery usually takes 30–60 minutes; it takes longer for bilateral or laparoscopic procedures. The child is under general anesthesia and feels nothing.

In the first days, swelling, mild bruising, and tenderness in the groin and scrotum are expected. Pain is usually controlled with simple pain relievers (acetaminophen, and ibuprofen if needed); thanks to the regional block, the first few hours are generally comfortable.

For a palpable testicle, the reported success rate of orchiopexy in the literature is high; in most cases, the testicle remains in the scrotum with an intact blood supply. Risks increase the higher the testicle was positioned before surgery.

• The main possible complications are re-ascent of the testicle (from adhesions or insufficient mobilization), testicular atrophy (shrinkage from vascular strain), wound infection, and rarely, injury to the vas deferens. Most of these can be addressed if caught early; this is why regular follow-up is considered part of the surgery.