{"paper_id":"1095c1bd-9b0d-4c5e-bc6c-2644e6377c4d","body_text":"Prospective Evaluation of Laparoscopic and Open Second-Stage Fowler–Stephens Orchidopexy: Is Minimally Invasive Surgery Superior? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prospective Evaluation of Laparoscopic and Open Second-Stage Fowler–Stephens Orchidopexy: Is Minimally Invasive Surgery Superior? Fayaz Ahmad Najar, Ubayer Nabi, Gowhar Nazir Mufti, Aejaz Ahsan Baba, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8126362/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Dec, 2025 Read the published version in Journal of Pediatric Endoscopic Surgery → Version 1 posted You are reading this latest preprint version Abstract Background The optimal approach for second-stage Fowler–Stephens orchidopexy (FSO) in nonpalpable undescended testes remains controversial. While laparoscopy offers superior magnification and minimal invasiveness, the open approach is time-tested and widely practiced. This prospective randomized study compares outcomes of open and laparoscopic second-stage FSO to determine the better approach in terms of testicular viability and surgical success. Methods A prospective randomized study was conducted on 105 children with nonpalpable undescended testes. Patients were randomized into Group A (open group, n = 52) and Group B (laparoscopic group, n = 53). Both groups underwent diagnostic laparoscopy followed by laparoscopic vessel division in Stage 1. Only viable intra-abdominal testes proceeded to second-stage orchidopexy—38 of 52 in Group A and 41 of 53 in Group B. Primary outcomes included success rate and testicular viability, while secondary outcomes assessed operative time, complications, hospital stay, and cosmetic satisfaction. Results The mean age at surgery was 3.8 ± 2.1 years. Stage-1 operative times were similar between groups (45.2 ± 8.1 vs. 44.8 ± 7.9 minutes). The overall success rate was 91.1%, with no significant difference between the open and laparoscopic groups (89.5% vs. 92.7%, p = 0.719). The laparoscopic second stage demonstrated significantly shorter operative time (78.3 ± 14.7 vs. 94.6 ± 18.2 minutes, p < 0.05), reduced hospital stay (2.1 ± 0.7 vs. 3.2 ± 1.1 days, p < 0.01), and higher cosmetic satisfaction scores (9.1 ± 0.8 vs. 8.4 ± 1.2, p < 0.05). Complication rates were comparable (19.5% laparoscopic vs. 31.6% open, p = 0.278). At a mean follow-up of 24.8 months, 94.4% of testes were in a dependent scrotal position, and 90.3% maintained normal size. Conclusion Both open and laparoscopic second-stage Fowler–Stephens orchidopexy provide excellent outcomes in the management of nonpalpable undescended testes. Although overall success and viability rates are equivalent, the laparoscopic approach offers advantages of shorter operative time, reduced hospital stay, and superior cosmetic results. The choice of technique should be guided by surgeon expertise and institutional resources. Undescended testis Nonpalpable testis Fowler-Stephens orchidopexy Laparoscopy Figures Figure 1 Figure 2 Figure 3 Introduction Cryptorchidism, defined as the failure of one or both testes to descend into the scrotum, represents one of the most common congenital anomalies in male children, affecting approximately 1–4% of full-term newborns and up to 30% of premature infants ( 1 , 2 ). Among cases of cryptorchidism, nonpalpable undescended testes present a particularly challenging clinical scenario, accounting for approximately 20–30% of all undescended testes and requiring specialized diagnostic and therapeutic approaches ( 3 , 4 ). The significance of timely intervention for undescended testes extends beyond cosmetic concerns, encompassing serious long-term complications including increased risk of testicular malignancy, infertility, testicular torsion, and psychological impact related to genital appearance ( 5 , 6 ). The risk of testicular cancer in undescended testes is estimated to be 4–8 times higher than in normally descended testes, with intra-abdominal testes carrying the highest malignant potential ( 7 ). Furthermore, the optimal window for orchidopexy to preserve fertility potential is generally accepted to be before 18–24 months of age, when irreversible histological changes begin to occur in the undescended testis ( 8 ). The management of nonpalpable testes has evolved significantly over the past few decades, with laparoscopic exploration emerging as the gold standard for both diagnosis and treatment planning ( 9 ). Laparoscopy provides definitive information about testicular location, viability, and size, while simultaneously offering therapeutic options. When viable intra-abdominal testes are identified with inadequate length for single-stage orchidopexy, the Fowler-Stephens procedure, involving division of testicular vessels with reliance on collateral circulation through the vas deferens and cremasteric arteries, has become the preferred approach ( 10 , 11 ). The Fowler-Stephens orchidopexy can be performed as either a single-stage or two-stage procedure, with the latter gaining preference due to improved success rates. The two-stage approach allows for the development of collateral circulation following initial vessel division, theoretically reducing the risk of testicular atrophy ( 12 ). While this procedure was traditionally performed through open surgical techniques, the advent of minimally invasive surgery has introduced laparoscopic approaches that offer potential advantages including reduced morbidity, shorter recovery time, better cosmetic outcomes, and superior visualization of intra-abdominal anatomy ( 13 ). This study was done to compare the outcomes of open versus laparoscopic second-stage Fowler-Stephens orchidopexy. By analyzing the clinical presentation, diagnostic findings, and surgical outcomes, we seek to contribute valuable data to guide evidence-based management of this challenging condition in our region and provide insights relevant to similar populations globally. Materials and Methods Study Design and Setting This prospective randomized study was conducted at SKIMS, Soura, Srinagar over a period of 3 years from 2022 to 2025. The study was conducted in accordance with the principles of the Declaration of Helsinki (latest version) and good clinical practice guidelines. Patient confidentiality was maintained throughout the study period, and all data were anonymized for analysis and publication purposes. Study Population A total of 105 children with nonpalpable undescended testes were included in this study. The study population comprised male children aged 6 months to 12 years presenting to the pediatric surgery department with clinical evidence of nonpalpable cryptorchidism. Inclusion Criteria Male children aged 6 months to 12 years Clinical diagnosis of unilateral or bilateral nonpalpable undescended testes Absence of palpable testis on careful examination under anesthesia Parents/guardians willing to provide informed consent and comply with follow-up requirements Exclusion Criteria Children with palpable undescended testes Previous inguinal or scrotal surgery Associated major congenital anomalies or chromosomal disorders Patients with bleeding disorders or contraindications to surgery Lost to follow-up before completion of treatment protocol Preoperative Assessment All patients underwent comprehensive preoperative evaluation including detailed history taking, physical examination, and relevant investigations. Physical examination was performed by two independent pediatric surgeons, with examination under anesthesia conducted when necessary to confirm the nonpalpable nature of the testis. Routine preoperative investigations included complete blood count, coagulation profile, and fitness assessment for anesthesia. Ultrasonography of the abdomen and pelvis was performed in all cases, though its diagnostic limitations for nonpalpable testes were acknowledged. Hormonal evaluation including luteinizing hormone (LH), follicle-stimulating hormone (FSH), and inhibin B levels were assessed in selected cases, particularly in bilateral nonpalpable testes, to evaluate testicular function. Randomization and Group Allocation Patients meeting the inclusion criteria were randomly allocated to two treatment groups using computer-generated randomization: Group A (Open Second Stage) : Two-stage Fowler-Stephens orchidopexy with laparoscopic vessel division followed by open orchidopexy Group B (Laparoscopic Second Stage) : Two-stage Fowler-Stephens orchidopexy with laparoscopic vessel division followed by laparoscopic orchidopexy Randomization was performed using sealed envelope technique to ensure allocation concealment. Block randomization with varying block sizes was employed to maintain balanced group sizes throughout the study period. Surgical Techniques Diagnostic Laparoscopy All patients, regardless of group allocation, underwent initial diagnostic laparoscopy to locate the testis and assess its viability. The procedure was performed under general anesthesia with the patient in Trendelenburg position. Three 5mm ports were used: one umbilical port for the camera and two working ports placed laterally. Laparoscopic findings were classified according to established criteria: Viable intra-abdominal testis with adequate size Atrophic intra-abdominal testis Testicular absence (vanishing testis) Testis entering the internal inguinal ring Group A: Two-Stage Fowler-Stephens Orchidopexy with Open Second Stage Stage 1 (Laparoscopic Vessel Division) : All patients underwent laparoscopic division of testicular vessels using electrocautery or ultrasonic dissection, ensuring preservation of the vas deferens and its vascular supply. This stage was identical for both groups. Stage 2 (Open Orchidopexy) : Six months after the first stage, open orchidopexy was performed through an inguinal approach. The testis was mobilized with careful preservation of collateral circulation through the vasal vessels, and positioned in a subdartos pouch created in the scrotum. Group B: Two-Stage Fowler-Stephens Orchidopexy with Laparoscopic Second Stage Stage 1 (Laparoscopic Vessel Division) : Identical to Group A - laparoscopic division of testicular vessels was performed using electrocautery or ultrasonic dissection, ensuring preservation of the vas deferens and its vascular supply. Stage 2 (Laparoscopic Orchidopexy) : After a six-month interval, laparoscopic orchidopexy was performed. The testis was mobilized laparoscopically with preservation of vasal vessels and brought down to the scrotum through a newly created inguinal canal or through a separate scrotal approach. Outcome Measures Primary Outcomes Testicular viability and position at final follow-up Success rate defined as viable testis in dependent scrotal position Testicular atrophy rate Secondary Outcomes Operative time for each stage Intraoperative complications Postoperative complications (wound infection, bleeding, bowel injury) Length of hospital stay Time to return to normal activities Cosmetic satisfaction score (assessed by parents) Long-term complications during follow-up period Follow-up Protocol Patients were followed up at regular intervals: 2 weeks, 6 weeks, 3 months, 6 months, and annually thereafter. At each follow-up visit, clinical examination was performed to assess testicular position, size, and consistency. Testicular atrophy was defined as >20% reduction in testicular size compared to the contralateral testis or preoperative measurements. Ultrasonographic assessment was performed at 6 months and annually to evaluate testicular size and echogenicity. Long-term follow-up focused on testicular growth, hormonal function assessment in selected cases, and identification of any late complications. Statistical Analysis Statistical analysis was performed using SPSS version [version number]. Continuous variables were expressed as mean ± standard deviation or median with interquartile range, depending on data distribution. Categorical variables were presented as frequencies and percentages. Comparison between groups was performed using Student's t-test for normally distributed continuous variables, Mann-Whitney U test for non-parametric data, and chi-square test or Fisher's exact test for categorical variables. A p-value of <0.05 was considered statistically significant. All analyses were performed on an intention-to-treat basis. Results Patient Demographics and Baseline Characteristics Table 1 summarizes the baseline demographic and clinical characteristics of the study population. A total of 105 children with nonpalpable undescended testes were included, with 52 randomized to the open second-stage Fowler–Stephens orchidopexy (Group A) and 53 to the laparoscopic second-stage procedure (Group B) . The mean age of patients was comparable between the two groups (3.7 ± 2.0 years in Group A vs. 3.9 ± 2.2 years in Group B; p = 0.623). Age distribution across the predefined categories (6 months–2 years, 2–5 years, and 5–12 years) also showed no significant difference ( p = 0.451), indicating appropriate randomization and homogeneity. Similarly, mean body weight did not differ significantly between groups (16.2 ± 4.8 kg vs. 16.8 ± 5.1 kg; p = 0.534). The laterality of undescended testes (right, left, or bilateral involvement) was comparable between both groups ( p = 0.789). Right-sided testes were slightly more common overall (55.2%), followed by left-sided (40.0%) and bilateral cases (4.8%). There was also no statistically significant difference in the prevalence of associated anomalies between the two groups (15.4% in Group A vs. 17.0% in Group B; p = 0.826). Overall, these findings confirm that both groups were well matched at baseline , ensuring that subsequent outcome comparisons were not influenced by demographic or preoperative differences Table 1 Patient Demographics and Baseline Characteristics Parameter Group A (Open Stage 2) n = 52 Group B (Laparoscopic Stage 2) n = 53 Total n = 105 p-value Age (years), mean ± SD 3.7 ± 2.0 3.9 ± 2.2 3.8 ± 2.1 0.623 Age distribution 0.451 6 months − 2 years 18 (34.6%) 16 (30.2%) 34 (32.4%) 2–5 years 22 (42.3%) 25 (47.2%) 47 (44.8%) 5–12 years 12 (23.1%) 12 (22.6%) 24 (22.8%) Weight (kg), mean ± SD 16.2 ± 4.8 16.8 ± 5.1 16.5 ± 4.9 0.534 Laterality 0.789 Right side 28 (53.8%) 30 (56.6%) 58 (55.2%) Left side 22 (42.3%) 20 (37.7%) 42 (40.0%) Bilateral 2 (3.8%) 3 (5.7%) 5 (4.8%) Associated anomalies 8 (15.4%) 9 (17.0%) 17 (16.2%) 0.826 Diagnostic Laparoscopy Findings Table 2 outlines the intraoperative findings encountered during diagnostic laparoscopy in both study groups. A viable intra-abdominal testis was the most common finding, identified in 75.2% (79/105) of all patients, with similar distribution between Group A (73.1%) and Group B (77.4%). Atrophic intra-abdominal testes were noted in 10.5% of cases, again with comparable occurrence between the open and laparoscopic groups (11.5% vs. 9.4%). A vanishing testis was documented in 8.6% of patients, reflecting complete regression or absent gonadal tissue. Additionally, testis located at the internal ring was seen in 5.7% of the cohort, equally distributed between the two groups. The mean testicular size at laparoscopy was similar between groups (1.2 ± 0.4 cm in Group A vs. 1.3 ± 0.3 cm in Group B), with an overall mean of 1.25 ± 0.35 cm, indicating no significant baseline difference in gonadal size before the second-stage procedure. These findings confirm that the anatomical distribution and status of intra-abdominal testes were comparable between both surgical arms , supporting the validity of outcome comparisons following the second-stage Fowler–Stephens orchidopexy. Table 2 Diagnostic Laparoscopy Findings Laparoscopic Finding Group A n = 52 Group B n = 53 Total n = 105 Percentage Viable intra-abdominal testis 38 (73.1%) 41 (77.4%) 79 (75.2%) 75.2% Atrophic intra-abdominal testis 6 (11.5%) 5 (9.4%) 11 (10.5%) 10.5% Vanishing testis 5 (9.6%) 4 (7.5%) 9 (8.6%) 8.6% Testis at internal ring 3 (5.8%) 3 (5.7%) 6 (5.7%) 5.7% Mean testicular size (cm) 1.2 ± 0.4 1.3 ± 0.3 1.25 ± 0.35 - Surgical Outcomes and Success Rates Table 3 summarizes the perioperative and postoperative outcomes between children who underwent open second-stage Fowler–Stephens orchidopexy (Group A) and those treated with the laparoscopic second-stage approach (Group B) . Since Stage 1 laparoscopy and vessel clipping were identical for all patients, no significant differences were observed in Stage 1 parameters. The mean operative time for Stage 1 was similar in both groups (45.2 ± 8.1 minutes vs. 44.8 ± 7.9 minutes; p = 0.825), with a low and comparable rate of intraoperative complications (2.6% vs. 2.4%). The duration of hospital stay following Stage 1 was also equivalent between the two groups ( p = 0.342). In contrast, Stage 2 outcomes , which differed based on surgical technique, demonstrated notable distinctions. The mean operative time was significantly longer in the open group (94.6 ± 18.2 minutes) compared with the laparoscopic group (78.3 ± 14.7 minutes; p < 0.001). Conversion to open surgery occurred in 3 patients (7.3%) in the laparoscopic arm, reflecting intraoperative difficulty or inadequate mobilization. Intraoperative complication rates during Stage 2 were low and not significantly different (7.9% vs. 4.9%; p = 0.667). Postoperatively, children in the laparoscopic group had a significantly shorter hospital stay (2.1 ± 0.7 days) compared with those in the open group (3.2 ± 1.1 days; p < 0.001), demonstrating a clear advantage of minimally invasive surgery regarding recovery and postoperative morbidity. The overall success rate of orchidopexy was high in both groups, with no statistically significant difference (89.5% in Group A vs. 92.7% in Group B; p = 0.719). Testicular atrophy occurred in 10.5% of patients in the open group and 7.3% in the laparoscopic group, which was also not statistically significant ( p = 0.719). Table 3 Surgical Outcomes Comparison Outcome Parameter Group A (Open Stage 2) n = 38 Group B (Laparoscopic Stage 2) n = 41 p-value Stage 1 Outcomes (Identical for both groups) Mean operative time (minutes) 45.2 ± 8.1 44.8 ± 7.9 0.825 Intraoperative complications 1 (2.6%) 1 (2.4%) 1.000 Hospital stay (days) 1.2 ± 0.4 1.3 ± 0.5 0.342 Stage 2 Outcomes (Different approaches) Mean operative time (minutes) 94.6 ± 18.2 78.3 ± 14.7 < 0.001 Conversion to open - 3 (7.3%) - Intraoperative complications 3 (7.9%) 2 (4.9%) 0.667 Hospital stay (days) 3.2 ± 1.1 2.1 ± 0.7 < 0.001 Overall Success Rate Successful orchidopexy 34 (89.5%) 38 (92.7%) 0.719 Testicular atrophy 4 (10.5%) 3 (7.3%) 0.719 Postoperative Complications Table 4 outlines the early and late postoperative complications following open and laparoscopic second-stage Fowler–Stephens orchidopexy. Overall, both approaches demonstrated a low complication profile , with no statistically significant differences across any measured parameters. Early postoperative complications (≤ 30 days) Early postoperative morbidity was generally mild. Wound infection occurred more frequently in the open group (10.5%) than in the laparoscopic group (2.4%), although this difference did not reach statistical significance ( p = 0.185). Minor bleeding or hematoma was noted in 5.3% of open cases compared to 2.4% in the laparoscopic arm ( p = 0.605). Scrotal edema was the most common early complication, reported in 21.1% of open procedures and 14.6% of laparoscopic procedures ( p = 0.564). Postoperative fever occurred in 7.9% and 4.9% of patients in the open and laparoscopic groups respectively ( p = 0.667). Late postoperative complications (> 30 days) Late complications were infrequent in both cohorts. Testicular retraction occurred in 5.3% of open cases and 2.4% of laparoscopic cases ( p = 0.605). The incidence of hydrocele formation was low and similar in both groups (7.9% vs. 4.9%, p = 0.667). Chronic postoperative pain was rare and reported only in one patient in the open group (2.6%), with none documented in the laparoscopic group ( p = 0.481). Overall complication rate The total complication rate was higher in the open surgery group (31.6%) compared with the laparoscopic group (19.5%); however, this difference did not reach statistical significance ( p = 0.278). Table 4 Postoperative Complications Complication Group A (Open Stage 2) n = 38 Group B (Laparoscopic Stage 2) n = 41 p-value Early Complications (≤ 30 days) Wound infection 4 (10.5%) 1 (2.4%) 0.185 Bleeding/hematoma 2 (5.3%) 1 (2.4%) 0.605 Scrotal edema 8 (21.1%) 6 (14.6%) 0.564 Fever 3 (7.9%) 2 (4.9%) 0.667 Late Complications (> 30 days) Testicular retraction 2 (5.3%) 1 (2.4%) 0.605 Hydrocele formation 3 (7.9%) 2 (4.9%) 0.667 Chronic pain 1 (2.6%) 0 (0%) 0.481 Total Complications 12 (31.6%) 8 (19.5%) 0.278 Follow-up Results and Long-term Outcome Table 5 summarizes the follow-up results and long-term outcome. Long-term follow-up was available for 34 patients in the open group (Group A) and 38 patients in the laparoscopic group (Group B). The mean duration of follow-up was comparable between the two groups ( 24.2 ± 6.8 vs. 25.3 ± 6.1 months; p = 0.468 ), indicating adequate and equivalent postoperative surveillance. Testicular Position At final follow-up, the majority of testes in both groups were located in the dependent scrotum , with no significant difference in distribution of final testicular position ( p = 0.894 ). Dependent scrotal: 94.1% (Group A) vs. 94.7% (Group B) Mid-scrotal: 5.9% in both groups No cases of high-scrotal or extrascrotal testicular location were observed. Testicular Size Preservation Testicular volume outcomes were also similar across groups. Normal size (> 80% of contralateral) : 88.2% (Group A) vs. 92.1% (Group B) ( p = 0.713 ) Mild atrophy (60–80%) : 8.8% vs. 5.3% ( p = 0.659 ) Significant atrophy (< 60%) : seen in only 1 patient per group , reflecting equivalent long-term vascular preservation ( p = 1.000 ). These findings indicate that both open and laparoscopic second-stage Fowler–Stephens orchidopexy achieve excellent long-term testicular viability and volume preservation . Cosmetic Outcome Cosmetic satisfaction, assessed on a 10-point scale, was significantly higher in the laparoscopic group ( 9.1 ± 0.8 ) compared with the open group ( 8.4 ± 1.2; p = 0.003 ). The superior cosmetic results are attributable to the smaller incisions and reduced scrotal scarring in the laparoscopic approach. Return to Normal Activities Children undergoing laparoscopic Stage 2 surgery resumed normal activities significantly earlier than those in the open group: 10.8 ± 2.4 days vs. 14.6 ± 3.2 days ( p < 0.001 ). This suggests a smoother postoperative recovery and reduced morbidity with the minimally invasive technique. Table 5 Long-term Follow-up Outcomes Parameter Group A (Open Stage 2) n = 34* Group B (Laparoscopic Stage 2) n = 38* p-value Mean follow-up (months) 24.2 ± 6.8 25.3 ± 6.1 0.468 Testicular position 0.894 Dependent scrotal 32 (94.1%) 36 (94.7%) Mid-scrotal 2 (5.9%) 2 (5.3%) High scrotal 0 (0%) 0 (0%) Testicular size preservation Normal size (> 80% of contralateral) 30 (88.2%) 35 (92.1%) 0.713 Mild atrophy (60–80%) 3 (8.8%) 2 (5.3%) 0.659 Significant atrophy (< 60%) 1 (2.9%) 1 (2.6%) 1.000 Cosmetic satisfaction score ( 1 – 10 ) 8.4 ± 1.2 9.1 ± 0.8 0.003 Return to normal activities (days) 14.6 ± 3.2 10.8 ± 2.4 < 0.001 *Only successful cases included in long-term analysis. The pattern of testicular preservation during the follow-up period is shown in Fig. 1. The cosmetic satisfaction scores between Open Second Stage and Laparoscopic Second Stage Orchidopexy are shown in Fig. 2. Cost Analysis Table 6 presents a detailed comparison of the economic implications of open versus laparoscopic second-stage Fowler–Stephens orchidopexy. Despite notable differences in individual cost components, the overall treatment cost remained comparable between the two groups. The equipment cost per case was significantly higher in the laparoscopic group (4,560 ± 420) compared with the open approach (2,840 ± 320; p < 0.001), reflecting the expense of laparoscopic instruments and energy devices. Consequently, the total operative cost was also substantially greater for laparoscopic procedures (11,240 ± 1,320 vs. 8,640 ± 980; p < 0.001). In contrast, patients undergoing laparoscopic Stage 2 surgery incurred significantly lower hospital costs (4,280 ± 780) compared with those in the open group (6,420 ± 1,140; p < 0.001). This reduction is attributable to shorter postoperative recovery times and decreased length of stay associated with the minimally invasive approach. Interestingly, when all components were combined, the total treatment cost —encompassing operative, equipment, and hospital expenditures—did not differ significantly between groups (15,520 ± 1,580 for laparoscopic vs. 15,060 ± 1,680 for open; p = 0.198). This demonstrates that despite higher operative expenses, the cost savings resulting from shorter hospitalization offset much of the additional laparoscopic expenditure. Overall, these findings indicate that while the laparoscopic technique is more expensive intraoperatively, its associated reductions in postoperative care requirements produce a cost-neutral overall outcome compared with the open approach. Table 6 Cost Comparison (in local currency) Cost Component Group A (Open Stage 2) Group B (Laparoscopic Stage 2) p-value Equipment cost per case 2,840 ± 320 4,560 ± 420 < 0.001 Total operative cost 8,640 ± 980 11,240 ± 1,320 < 0.001 Hospital cost 6,420 ± 1,140 4,280 ± 780 < 0.001 Total treatment cost 15,060 ± 1,680 15,520 ± 1,580 0.198 Subgroup Analysis Analysis of outcomes based on patient age showed that children younger than 2 years had comparable success rates in both groups (Open: 16/18, 88.9% vs Laparoscopic: 15/16, 93.8%; p = 0.642). Similarly, no significant difference was observed in bilateral cases, though the sample size was limited (Group A: 1/1, 100% vs Group B: 2/2, 100%), as shown in Fig. 4. Discussion Surgical Outcomes and Success Rates The overall success rate of 91.1% for two-stage Fowler-Stephens orchidopexy in our study compares favorably with reported rates of 85–95% in the literature ( 11 , 14 ). Importantly, we found no statistically significant difference in success rates between open (89.5%) and laparoscopic (92.7%) second-stage approaches, supporting the equivalence of both techniques in achieving the primary objective of successful orchidopexy when preceded by standardized laparoscopic vessel division. The significantly shorter operative times observed in the laparoscopic group for Stage 2 orchidopexy (78.3 vs 94.6 minutes) reflect the enhanced visualization and precision offered by minimally invasive techniques for the second stage ( 13 ). Since Stage 1 was identical for both groups (laparoscopic vessel division), this efficiency advantage is specifically attributable to the laparoscopic approach for testicular mobilization and positioning. The 7.3% conversion rate from laparoscopic to open approach in our series falls within the acceptable range reported in pediatric laparoscopic surgery and primarily occurred due to dense adhesions from previous procedures or technical difficulties in testicular mobilization ( 15 ). Postoperative Recovery and Complications The laparoscopic approach for Stage 2 demonstrated clear advantages in postoperative recovery, with significantly shorter hospital stays and faster return to normal activities. These findings align with the well-established benefits of minimally invasive surgery and have important implications for healthcare resource utilization and family convenience ( 16 ). While the overall complication rate was numerically lower in the laparoscopic second-stage group (19.5% vs 31.6%), this difference did not reach statistical significance, likely due to our sample size. The types of complications observed were predominantly minor and comparable between groups, suggesting that both second-stage techniques carry similar safety profiles when performed by experienced surgeons following standardized laparoscopic vessel division. Long-term Outcomes and Testicular Preservation The comparable rates of testicular size preservation between groups (92.1% laparoscopic vs 88.2% open) support the effectiveness of both approaches in maintaining testicular viability through the staged procedure. This finding is crucial given that testicular atrophy remains the most significant concern with the Fowler-Stephens technique ( 12 ). The six-month interval between stages, based on established protocols, appears adequate for developing collateral circulation through vasal vessels. Some authors have suggested shorter intervals, but our results support the traditional approach ( 17 ). Cosmetic and Functional Considerations The significantly superior cosmetic satisfaction scores in the laparoscopic group (9.1 vs 8.4) reflect the reduced scarring associated with minimally invasive approaches. While this difference may appear modest, cosmetic outcomes are increasingly important to families and can impact long-term psychological well-being in these children. Long-term fertility assessment was beyond the scope of this study but remains a critical endpoint for future research. The preservation of testicular size and position achieved in both groups provides an encouraging foundation for reproductive potential, though hormonal and semen analysis in adolescence will be necessary to definitively assess fertility outcomes ( 18 ). Cost Considerations Our cost analysis revealed that while laparoscopic procedures incurred higher equipment and operative costs, the reduced hospital stay partially offset these expenses, resulting in comparable total treatment costs. This economic equivalence, combined with the clinical advantages of laparoscopy, supports its preferential use when expertise is available. Limitations and Future Directions Several limitations warrant acknowledgment. The relatively short follow-up period (mean 24.8 months) precludes assessment of long-term fertility and malignancy outcomes. Additionally, the single-center design may limit generalizability, though our experience likely reflects that of other tertiary centers managing similar case volumes. Future research should focus on longer-term follow-up studies evaluating hormonal function, fertility potential, and psychological outcomes. Comparative studies examining single-stage versus two-stage approaches in appropriately selected cases may also provide valuable insights for optimizing treatment algorithms. Clinical Implications Our results suggest that laparoscopic second-stage orchidopexy should be considered the preferred approach for managing viable intra-abdominal testes when surgical expertise is available, following standardized laparoscopic vessel division. The technique offers comparable success rates to open second-stage surgery while providing advantages in operative efficiency, recovery time, and cosmetic outcomes. For centers with limited laparoscopic experience, open second-stage orchidopexy following laparoscopic vessel division remains a viable and effective option with excellent success rates. The key to optimal outcomes lies in appropriate case selection, meticulous surgical technique for both stages, and comprehensive long-term follow-up regardless of the chosen second-stage approach. Conclusion In conclusion, both open and laparoscopic two-stage Fowler-Stephens orchidopexy represent effective treatments for nonpalpable undescended testes. The choice between techniques should be guided by the surgical expertise, institutional resources, and patient-specific factors, with the understanding that both approaches can achieve excellent clinical outcomes when performed by experienced pediatric surgeons. Declarations Ethics approval and consent to participate The study protocol was submitted and approved by the Institutional Ethics Committee (IEC-SKIMS). Appropriate Written Informed Consent was obtained from the parents and/or guardians of all participating patients. Consent for publication: Not applicable. Availability of data and material: The datasets used and/or analyzed during the study has been provided in the main manuscript and is also available with the corresponding author on reasonable request. Competing of Interests: The authors declare no competing interests. Source of funding: No external source of funding. Author contribution statement: FAN, MAG, UN, GNM, AAB and NAB: Conceptualization, Data Curation, Formal analysis, Funding acquisition, Investigation, Methodology, Projection administration, Resources, Software, Supervision, Validation, Visualization, Writing- original draft, Writing- review and editing. All authors approved the final manuscript for publication. References Kolon TF, Herndon CD, Baker LA et al (2014) Evaluation and treatment of cryptorchidism: AUA guideline. J Urol 192(2):337–345 Hutson JM, Balic A, Nation T, Southwell B, Cryptorchidism (2010) Semin Pediatr Surg 19(3):215–224 Tasian GE, Copp HL, Baskin LS (2011) Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness. J Pediatr Urol 7(1):75–82 Elder JS (2001) Cryptorchidism: isolated and associated with other genitourinary defects. Pediatr Clin North Am 48(6):1479–1494 Wood HM, Elder JS (2009) Cryptorchidism and testicular cancer: separating fact from fiction. J Urol 181(2):452–461 Foresta C, Zuccarello D, Garolla A, Ferlin A (2008) Role of hormones, genes, and environment in human cryptorchidism. Endocr Rev 29(5):560–580 Dieckmann KP, Pichlmeier U (2004) Clinical epidemiology of testicular germ cell tumors. World J Urol 22(1):2–14 Ritzén EM, Bergh A, Bjerknes R, Christiansen P et al (2007) Nordic consensus on treatment of undescended testes. Acta Paediatr 96(5):638–643 Esposito C, Caldamone AA, Settimi A, El-Ghoneimi A (2008) Management of boys with nonpalpable undescended testis. Nat Clin Pract Urol 5(5):252–260 Baker LA, Docimo SG, Surer I et al (2001) A multi-institutional analysis of laparoscopic orchidopexy. BJU Int 87(6):484–489 Fowler R, Stephens FD (1959) The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Z J Surg 29(2):92–106 Lindgren BW, Darby EC, Faiella L et al (1998) Laparoscopic orchiopexy: procedure of choice for the nonpalpable testis? J Urol 159(6):2132–2135 Esposito C, Vallasciani S, Settimi A et al (2004) Current indications and results of laparoscopic orchiopexy for cryptorchid testis. Surg Endosc 18(7):1090–1094 Mouriquand PD, Persad R, Sharma S (1998) The undescended testis: current concepts and controversies. Pediatr Surg Int 13(5–6):367–372 Docimo SG (1996) Testicular descent and ascent in the first year of life. Urology 48(3):458–460 Esposito C, Escolino M, Turra F et al (2016) Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg 25(4):232–240 Jordan GH, Winslow BH (1993) Laparoendoscopic upper pole nephrectomy with ureterectomy. J Urol 150(3):940–943 Lee PA, Houk CP, Cryptorchidism (2013) Curr Opin Endocrinol Diabetes Obes 20(3):210–216 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Dec, 2025 Read the published version in Journal of Pediatric Endoscopic Surgery → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8126362\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":549404170,\"identity\":\"9bdf5b26-8ec6-4f08-be5c-804167423f53\",\"order_by\":0,\"name\":\"Fayaz Ahmad 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10:07:43\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":50727,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eShowing testicular size preservation over follow-up period\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8126362/v1/3d5a49e2575811196c18f79c.png\"},{\"id\":97140956,\"identity\":\"fb223e98-afe2-4adc-a0d7-1bfa7d8bb209\",\"added_by\":\"auto\",\"created_at\":\"2025-12-01 10:06:00\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":32047,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eComparing the cosmetic satisfaction scores between the two groups\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8126362/v1/c6297f37ba37af1a3988bee9.png\"},{\"id\":97114103,\"identity\":\"d18faac8-dd7d-4c59-984f-fe655fff4f74\",\"added_by\":\"auto\",\"created_at\":\"2025-12-01 06:57:11\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":33232,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eShowing subgroup analysis results\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8126362/v1/af5cb7a5290bab5623fe0e94.png\"},{\"id\":99172262,\"identity\":\"b6fee1d3-c9a8-41cc-8609-b9c1042251b3\",\"added_by\":\"auto\",\"created_at\":\"2025-12-29 16:06:36\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2299898,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8126362/v1/f733b7d9-1dab-4609-aafe-00526cc3c2bd.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eProspective Evaluation of Laparoscopic and Open Second-Stage Fowler–Stephens Orchidopexy: Is Minimally Invasive Surgery Superior?\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eCryptorchidism, defined as the failure of one or both testes to descend into the scrotum, represents one of the most common congenital anomalies in male children, affecting approximately 1\\u0026ndash;4% of full-term newborns and up to 30% of premature infants (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). Among cases of cryptorchidism, nonpalpable undescended testes present a particularly challenging clinical scenario, accounting for approximately 20\\u0026ndash;30% of all undescended testes and requiring specialized diagnostic and therapeutic approaches (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe significance of timely intervention for undescended testes extends beyond cosmetic concerns, encompassing serious long-term complications including increased risk of testicular malignancy, infertility, testicular torsion, and psychological impact related to genital appearance (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). The risk of testicular cancer in undescended testes is estimated to be 4\\u0026ndash;8 times higher than in normally descended testes, with intra-abdominal testes carrying the highest malignant potential (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). Furthermore, the optimal window for orchidopexy to preserve fertility potential is generally accepted to be before 18\\u0026ndash;24 months of age, when irreversible histological changes begin to occur in the undescended testis (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe management of nonpalpable testes has evolved significantly over the past few decades, with laparoscopic exploration emerging as the gold standard for both diagnosis and treatment planning (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). Laparoscopy provides definitive information about testicular location, viability, and size, while simultaneously offering therapeutic options. When viable intra-abdominal testes are identified with inadequate length for single-stage orchidopexy, the Fowler-Stephens procedure, involving division of testicular vessels with reliance on collateral circulation through the vas deferens and cremasteric arteries, has become the preferred approach (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe Fowler-Stephens orchidopexy can be performed as either a single-stage or two-stage procedure, with the latter gaining preference due to improved success rates. The two-stage approach allows for the development of collateral circulation following initial vessel division, theoretically reducing the risk of testicular atrophy (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). While this procedure was traditionally performed through open surgical techniques, the advent of minimally invasive surgery has introduced laparoscopic approaches that offer potential advantages including reduced morbidity, shorter recovery time, better cosmetic outcomes, and superior visualization of intra-abdominal anatomy (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThis study was done to compare the outcomes of open versus laparoscopic second-stage Fowler-Stephens orchidopexy. By analyzing the clinical presentation, diagnostic findings, and surgical outcomes, we seek to contribute valuable data to guide evidence-based management of this challenging condition in our region and provide insights relevant to similar populations globally.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eStudy Design and Setting\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis prospective randomized study was conducted at SKIMS, Soura, Srinagar over a period of 3 years from 2022 to 2025. The study was conducted in accordance with the principles of the \\u003cstrong\\u003eDeclaration of Helsinki\\u003c/strong\\u003e (latest version) and good clinical practice guidelines. Patient confidentiality was maintained throughout the study period, and all data were anonymized for analysis and publication purposes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStudy Population\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 105 children with nonpalpable undescended testes were included in this study. The study population comprised male children aged 6 months to 12 years presenting to the pediatric surgery department with clinical evidence of nonpalpable cryptorchidism.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInclusion Criteria\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cul type=\\\"disc\\\"\\u003e\\n \\u003cli\\u003eMale children aged 6 months to 12 years\\u003c/li\\u003e\\n \\u003cli\\u003eClinical diagnosis of unilateral or bilateral nonpalpable undescended testes\\u003c/li\\u003e\\n \\u003cli\\u003eAbsence of palpable testis on careful examination under anesthesia\\u003c/li\\u003e\\n \\u003cli\\u003eParents/guardians willing to provide informed consent and comply with follow-up requirements\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eExclusion Criteria\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cul type=\\\"disc\\\"\\u003e\\n \\u003cli\\u003eChildren with palpable undescended testes\\u003c/li\\u003e\\n \\u003cli\\u003ePrevious inguinal or scrotal surgery\\u003c/li\\u003e\\n \\u003cli\\u003eAssociated major congenital anomalies or chromosomal disorders\\u003c/li\\u003e\\n \\u003cli\\u003ePatients with bleeding disorders or contraindications to surgery\\u003c/li\\u003e\\n \\u003cli\\u003eLost to follow-up before completion of treatment protocol\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePreoperative Assessment\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll patients underwent comprehensive preoperative evaluation including detailed history taking, physical examination, and relevant investigations. Physical examination was performed by two independent pediatric surgeons, with examination under anesthesia conducted when necessary to confirm the nonpalpable nature of the testis. Routine preoperative investigations included complete blood count, coagulation profile, and fitness assessment for anesthesia.\\u003c/p\\u003e\\n\\u003cp\\u003eUltrasonography of the abdomen and pelvis was performed in all cases, though its diagnostic limitations for nonpalpable testes were acknowledged. Hormonal evaluation including luteinizing hormone (LH), follicle-stimulating hormone (FSH), and inhibin B levels were assessed in selected cases, particularly in bilateral nonpalpable testes, to evaluate testicular function.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRandomization and Group Allocation\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePatients meeting the inclusion criteria were randomly allocated to two treatment groups using computer-generated randomization:\\u003c/p\\u003e\\n\\u003cul type=\\\"disc\\\"\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003eGroup A (Open Second Stage)\\u003c/strong\\u003e: Two-stage Fowler-Stephens orchidopexy with laparoscopic vessel division followed by open orchidopexy\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003eGroup B (Laparoscopic Second Stage)\\u003c/strong\\u003e: Two-stage Fowler-Stephens orchidopexy with laparoscopic vessel division followed by laparoscopic orchidopexy\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eRandomization was performed using sealed envelope technique to ensure allocation concealment. Block randomization with varying block sizes was employed to maintain balanced group sizes throughout the study period.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSurgical Techniques\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDiagnostic Laparoscopy\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll patients, regardless of group allocation, underwent initial diagnostic laparoscopy to locate the testis and assess its viability. The procedure was performed under general anesthesia with the patient in Trendelenburg position. Three 5mm ports were used: one umbilical port for the camera and two working ports placed laterally.\\u003c/p\\u003e\\n\\u003cp\\u003eLaparoscopic findings were classified according to established criteria:\\u003c/p\\u003e\\n\\u003cul type=\\\"disc\\\"\\u003e\\n \\u003cli\\u003eViable intra-abdominal testis with adequate size\\u003c/li\\u003e\\n \\u003cli\\u003eAtrophic intra-abdominal testis\\u003c/li\\u003e\\n \\u003cli\\u003eTesticular absence (vanishing testis)\\u003c/li\\u003e\\n \\u003cli\\u003eTestis entering the internal inguinal ring\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eGroup A: Two-Stage Fowler-Stephens Orchidopexy with Open Second Stage\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStage 1 (Laparoscopic Vessel Division)\\u003c/strong\\u003e: All patients underwent laparoscopic division of testicular vessels using electrocautery or ultrasonic dissection, ensuring preservation of the vas deferens and its vascular supply. This stage was identical for both groups.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStage 2 (Open Orchidopexy)\\u003c/strong\\u003e: Six months after the first stage, open orchidopexy was performed through an inguinal approach. The testis was mobilized with careful preservation of collateral circulation through the vasal vessels, and positioned in a subdartos pouch created in the scrotum.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eGroup B: Two-Stage Fowler-Stephens Orchidopexy with Laparoscopic Second Stage\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStage 1 (Laparoscopic Vessel Division)\\u003c/strong\\u003e: Identical to Group A - laparoscopic division of testicular vessels was performed using electrocautery or ultrasonic dissection, ensuring preservation of the vas deferens and its vascular supply.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStage 2 (Laparoscopic Orchidopexy)\\u003c/strong\\u003e: After a six-month interval, laparoscopic orchidopexy was performed. The testis was mobilized laparoscopically with preservation of vasal vessels and brought down to the scrotum through a newly created inguinal canal or through a separate scrotal approach.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eOutcome Measures\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePrimary Outcomes\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cul type=\\\"disc\\\"\\u003e\\n \\u003cli\\u003eTesticular viability and position at final follow-up\\u003c/li\\u003e\\n \\u003cli\\u003eSuccess rate defined as viable testis in dependent scrotal position\\u003c/li\\u003e\\n \\u003cli\\u003eTesticular atrophy rate\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSecondary Outcomes\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cul type=\\\"disc\\\"\\u003e\\n \\u003cli\\u003eOperative time for each stage\\u003c/li\\u003e\\n \\u003cli\\u003eIntraoperative complications\\u003c/li\\u003e\\n \\u003cli\\u003ePostoperative complications (wound infection, bleeding, bowel injury)\\u003c/li\\u003e\\n \\u003cli\\u003eLength of hospital stay\\u003c/li\\u003e\\n \\u003cli\\u003eTime to return to normal activities\\u003c/li\\u003e\\n \\u003cli\\u003eCosmetic satisfaction score (assessed by parents)\\u003c/li\\u003e\\n \\u003cli\\u003eLong-term complications during follow-up period\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFollow-up Protocol\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePatients were followed up at regular intervals: 2 weeks, 6 weeks, 3 months, 6 months, and annually thereafter. At each follow-up visit, clinical examination was performed to assess testicular position, size, and consistency. Testicular atrophy was defined as \\u0026gt;20% reduction in testicular size compared to the contralateral testis or preoperative measurements.\\u003c/p\\u003e\\n\\u003cp\\u003eUltrasonographic assessment was performed at 6 months and annually to evaluate testicular size and echogenicity. Long-term follow-up focused on testicular growth, hormonal function assessment in selected cases, and identification of any late complications.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eStatistical analysis was performed using SPSS version [version number]. Continuous variables were expressed as mean \\u0026plusmn; standard deviation or median with interquartile range, depending on data distribution. Categorical variables were presented as frequencies and percentages.\\u003c/p\\u003e\\n\\u003cp\\u003eComparison between groups was performed using Student\\u0026apos;s t-test for normally distributed continuous variables, Mann-Whitney U test for non-parametric data, and chi-square test or Fisher\\u0026apos;s exact test for categorical variables. A p-value of \\u0026lt;0.05 was considered statistically significant. All analyses were performed on an intention-to-treat basis.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003ePatient Demographics and Baseline Characteristics\\u003c/h2\\u003e\\u003cp\\u003eTable\\u0026nbsp;1 summarizes the baseline demographic and clinical characteristics of the study population. A total of \\u003cb\\u003e105 children\\u003c/b\\u003e with nonpalpable undescended testes were included, with \\u003cb\\u003e52\\u003c/b\\u003e randomized to the \\u003cb\\u003eopen second-stage Fowler\\u0026ndash;Stephens orchidopexy (Group A)\\u003c/b\\u003e and \\u003cb\\u003e53\\u003c/b\\u003e to the \\u003cb\\u003elaparoscopic second-stage procedure (Group B)\\u003c/b\\u003e.\\u003c/p\\u003e\\u003cp\\u003eThe \\u003cb\\u003emean age\\u003c/b\\u003e of patients was comparable between the two groups (3.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.0 years in Group A vs. 3.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.2 years in Group B; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.623). Age distribution across the predefined categories (6 months\\u0026ndash;2 years, 2\\u0026ndash;5 years, and 5\\u0026ndash;12 years) also showed no significant difference (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.451), indicating appropriate randomization and homogeneity.\\u003c/p\\u003e\\u003cp\\u003eSimilarly, \\u003cb\\u003emean body weight\\u003c/b\\u003e did not differ significantly between groups (16.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.8 kg vs. 16.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.1 kg; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.534).\\u003c/p\\u003e\\u003cp\\u003eThe \\u003cb\\u003elaterality of undescended testes\\u003c/b\\u003e (right, left, or bilateral involvement) was comparable between both groups (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.789). Right-sided testes were slightly more common overall (55.2%), followed by left-sided (40.0%) and bilateral cases (4.8%).\\u003c/p\\u003e\\u003cp\\u003eThere was also no statistically significant difference in the prevalence of \\u003cb\\u003eassociated anomalies\\u003c/b\\u003e between the two groups (15.4% in Group A vs. 17.0% in Group B; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.826).\\u003c/p\\u003e\\u003cp\\u003eOverall, these findings confirm that \\u003cb\\u003eboth groups were well matched at baseline\\u003c/b\\u003e, ensuring that subsequent outcome comparisons were not influenced by demographic or preoperative differences\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003ePatient Demographics and Baseline Characteristics\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eParameter\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eGroup A (Open Stage 2) n\\u0026thinsp;=\\u0026thinsp;52\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eGroup B (Laparoscopic Stage 2) n\\u0026thinsp;=\\u0026thinsp;53\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eTotal n\\u0026thinsp;=\\u0026thinsp;105\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003ep-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAge (years), mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.623\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAge distribution\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.451\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e6 months \\u0026minus;\\u0026thinsp;2 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e18 (34.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e16 (30.2%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e34 (32.4%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e2\\u0026ndash;5 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e22 (42.3%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25 (47.2%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e47 (44.8%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e5\\u0026ndash;12 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e12 (23.1%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12 (22.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e24 (22.8%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWeight (kg), mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e16.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e16.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e16.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.534\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLaterality\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.789\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRight side\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e28 (53.8%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e30 (56.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e58 (55.2%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLeft side\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e22 (42.3%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20 (37.7%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e42 (40.0%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eBilateral\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2 (3.8%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3 (5.7%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e5 (4.8%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAssociated anomalies\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e8 (15.4%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e9 (17.0%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e17 (16.2%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.826\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec20\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eDiagnostic Laparoscopy Findings\\u003c/h2\\u003e\\u003cp\\u003eTable\\u0026nbsp;2 outlines the intraoperative findings encountered during diagnostic laparoscopy in both study groups. A \\u003cb\\u003eviable intra-abdominal testis\\u003c/b\\u003e was the most common finding, identified in \\u003cb\\u003e75.2%\\u003c/b\\u003e (79/105) of all patients, with similar distribution between Group A (73.1%) and Group B (77.4%).\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eAtrophic intra-abdominal testes\\u003c/b\\u003e were noted in \\u003cb\\u003e10.5%\\u003c/b\\u003e of cases, again with comparable occurrence between the open and laparoscopic groups (11.5% vs. 9.4%). A \\u003cb\\u003evanishing testis\\u003c/b\\u003e was documented in \\u003cb\\u003e8.6%\\u003c/b\\u003e of patients, reflecting complete regression or absent gonadal tissue. Additionally, \\u003cb\\u003etestis located at the internal ring\\u003c/b\\u003e was seen in \\u003cb\\u003e5.7%\\u003c/b\\u003e of the cohort, equally distributed between the two groups.\\u003c/p\\u003e\\u003cp\\u003eThe \\u003cb\\u003emean testicular size\\u003c/b\\u003e at laparoscopy was similar between groups (1.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.4 cm in Group A vs. 1.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.3 cm in Group B), with an overall mean of 1.25\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.35 cm, indicating no significant baseline difference in gonadal size before the second-stage procedure.\\u003c/p\\u003e\\u003cp\\u003eThese findings confirm that the anatomical distribution and status of intra-abdominal testes were \\u003cb\\u003ecomparable between both surgical arms\\u003c/b\\u003e, supporting the validity of outcome comparisons following the second-stage Fowler\\u0026ndash;Stephens orchidopexy.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eDiagnostic Laparoscopy Findings\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLaparoscopic Finding\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eGroup A n\\u0026thinsp;=\\u0026thinsp;52\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eGroup B n\\u0026thinsp;=\\u0026thinsp;53\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eTotal n\\u0026thinsp;=\\u0026thinsp;105\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003ePercentage\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eViable intra-abdominal testis\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e38 (73.1%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e41 (77.4%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e79 (75.2%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e75.2%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAtrophic intra-abdominal testis\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e6 (11.5%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5 (9.4%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e11 (10.5%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e10.5%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVanishing testis\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5 (9.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4 (7.5%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e9 (8.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e8.6%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTestis at internal ring\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3 (5.8%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3 (5.7%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e6 (5.7%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e5.7%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMean testicular size (cm)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.25\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.35\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec21\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eSurgical Outcomes and Success Rates\\u003c/h2\\u003e\\u003cp\\u003eTable\\u0026nbsp;3 summarizes the perioperative and postoperative outcomes between children who underwent \\u003cb\\u003eopen second-stage Fowler\\u0026ndash;Stephens orchidopexy (Group A)\\u003c/b\\u003e and those treated with the \\u003cb\\u003elaparoscopic second-stage approach (Group B)\\u003c/b\\u003e. Since \\u003cb\\u003eStage 1 laparoscopy and vessel clipping were identical\\u003c/b\\u003e for all patients, no significant differences were observed in Stage 1 parameters. The mean operative time for Stage 1 was similar in both groups (45.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.1 minutes vs. 44.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.9 minutes; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.825), with a low and comparable rate of intraoperative complications (2.6% vs. 2.4%). The duration of hospital stay following Stage 1 was also equivalent between the two groups (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.342).\\u003c/p\\u003e\\u003cp\\u003eIn contrast, \\u003cb\\u003eStage 2 outcomes\\u003c/b\\u003e, which differed based on surgical technique, demonstrated notable distinctions. The \\u003cb\\u003emean operative time\\u003c/b\\u003e was significantly longer in the open group (94.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.2 minutes) compared with the laparoscopic group (78.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.7 minutes; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Conversion to open surgery occurred in \\u003cb\\u003e3 patients (7.3%)\\u003c/b\\u003e in the laparoscopic arm, reflecting intraoperative difficulty or inadequate mobilization. Intraoperative complication rates during Stage 2 were low and not significantly different (7.9% vs. 4.9%; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.667).\\u003c/p\\u003e\\u003cp\\u003ePostoperatively, children in the laparoscopic group had a \\u003cb\\u003esignificantly shorter hospital stay\\u003c/b\\u003e (2.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.7 days) compared with those in the open group (3.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.1 days; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), demonstrating a clear advantage of minimally invasive surgery regarding recovery and postoperative morbidity.\\u003c/p\\u003e\\u003cp\\u003eThe \\u003cb\\u003eoverall success rate of orchidopexy\\u003c/b\\u003e was high in both groups, with no statistically significant difference (89.5% in Group A vs. 92.7% in Group B; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.719). Testicular atrophy occurred in 10.5% of patients in the open group and 7.3% in the laparoscopic group, which was also not statistically significant (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.719).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eSurgical Outcomes Comparison\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOutcome Parameter\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eGroup A (Open Stage 2) n\\u0026thinsp;=\\u0026thinsp;38\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eGroup B (Laparoscopic Stage 2) n\\u0026thinsp;=\\u0026thinsp;41\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ep-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eStage 1 Outcomes (Identical for both groups)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMean operative time (minutes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e45.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e44.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.825\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eIntraoperative complications\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1 (2.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1 (2.4%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHospital stay (days)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.342\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eStage 2 Outcomes (Different approaches)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMean operative time (minutes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e94.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e78.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eConversion to open\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3 (7.3%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eIntraoperative complications\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3 (7.9%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2 (4.9%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.667\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHospital stay (days)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eOverall Success Rate\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSuccessful orchidopexy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e34 (89.5%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e38 (92.7%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.719\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTesticular atrophy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4 (10.5%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3 (7.3%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.719\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec22\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003ePostoperative Complications\\u003c/h2\\u003e\\u003cp\\u003eTable\\u0026nbsp;4 outlines the early and late postoperative complications following open and laparoscopic second-stage Fowler\\u0026ndash;Stephens orchidopexy. Overall, both approaches demonstrated a \\u003cb\\u003elow complication profile\\u003c/b\\u003e, with no statistically significant differences across any measured parameters.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec23\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003eEarly postoperative complications (\\u0026le;\\u0026thinsp;30 days)\\u003c/h2\\u003e\\u003cp\\u003eEarly postoperative morbidity was generally mild. \\u003cb\\u003eWound infection\\u003c/b\\u003e occurred more frequently in the open group (10.5%) than in the laparoscopic group (2.4%), although this difference did not reach statistical significance (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.185). Minor \\u003cb\\u003ebleeding or hematoma\\u003c/b\\u003e was noted in 5.3% of open cases compared to 2.4% in the laparoscopic arm (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.605). \\u003cb\\u003eScrotal edema\\u003c/b\\u003e was the most common early complication, reported in 21.1% of open procedures and 14.6% of laparoscopic procedures (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.564). Postoperative \\u003cb\\u003efever\\u003c/b\\u003e occurred in 7.9% and 4.9% of patients in the open and laparoscopic groups respectively (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.667).\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec24\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eLate postoperative complications (\\u0026gt;\\u0026thinsp;30 days)\\u003c/h2\\u003e\\u003cp\\u003eLate complications were infrequent in both cohorts. \\u003cb\\u003eTesticular retraction\\u003c/b\\u003e occurred in 5.3% of open cases and 2.4% of laparoscopic cases (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.605). The incidence of \\u003cb\\u003ehydrocele formation\\u003c/b\\u003e was low and similar in both groups (7.9% vs. 4.9%, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.667). \\u003cb\\u003eChronic postoperative pain\\u003c/b\\u003e was rare and reported only in one patient in the open group (2.6%), with none documented in the laparoscopic group (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.481).\\u003c/p\\u003e\\u003cdiv id=\\\"Sec25\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003eOverall complication rate\\u003c/h2\\u003e\\u003cp\\u003eThe \\u003cb\\u003etotal complication rate\\u003c/b\\u003e was higher in the open surgery group (31.6%) compared with the laparoscopic group (19.5%); however, this difference did not reach statistical significance (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.278).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003ePostoperative Complications\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eComplication\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eGroup A (Open Stage 2) n\\u0026thinsp;=\\u0026thinsp;38\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eGroup B (Laparoscopic Stage 2) n\\u0026thinsp;=\\u0026thinsp;41\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ep-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEarly Complications (\\u0026le;\\u0026thinsp;30 days)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWound infection\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4 (10.5%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1 (2.4%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.185\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eBleeding/hematoma\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2 (5.3%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1 (2.4%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.605\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eScrotal edema\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e8 (21.1%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e6 (14.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.564\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFever\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3 (7.9%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2 (4.9%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.667\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eLate Complications (\\u0026gt;\\u0026thinsp;30 days)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTesticular retraction\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2 (5.3%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1 (2.4%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.605\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHydrocele formation\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3 (7.9%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2 (4.9%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.667\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eChronic pain\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1 (2.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.481\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTotal Complications\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e12 (31.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8 (19.5%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.278\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec26\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003eFollow-up Results and Long-term Outcome\\u003c/h2\\u003e\\u003cp\\u003eTable\\u0026nbsp;5 summarizes the follow-up results and long-term outcome. Long-term follow-up was available for \\u003cb\\u003e34 patients\\u003c/b\\u003e in the open group (Group A) and \\u003cb\\u003e38 patients\\u003c/b\\u003e in the laparoscopic group (Group B). The \\u003cb\\u003emean duration of follow-up\\u003c/b\\u003e was comparable between the two groups (\\u003cem\\u003e24.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.8 vs. 25.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.1 months; p\\u0026thinsp;=\\u0026thinsp;0.468\\u003c/em\\u003e), indicating adequate and equivalent postoperative surveillance.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec27\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003eTesticular Position\\u003c/h2\\u003e\\u003cp\\u003eAt final follow-up, the \\u003cb\\u003emajority of testes in both groups were located in the dependent scrotum\\u003c/b\\u003e, with no significant difference in distribution of final testicular position (\\u003cem\\u003ep\\u0026thinsp;=\\u0026thinsp;0.894\\u003c/em\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003eDependent scrotal: \\u003cb\\u003e94.1% (Group A)\\u003c/b\\u003e vs. \\u003cb\\u003e94.7% (Group B)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eMid-scrotal: \\u003cb\\u003e5.9%\\u003c/b\\u003e in both groups\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eNo cases of high-scrotal or extrascrotal testicular location were observed.\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec28\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eTesticular Size Preservation\\u003c/h2\\u003e\\u003cp\\u003eTesticular volume outcomes were also similar across groups.\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eNormal size (\\u0026gt;\\u0026thinsp;80% of contralateral)\\u003c/b\\u003e: 88.2% (Group A) vs. 92.1% (Group B) (\\u003cem\\u003ep\\u0026thinsp;=\\u0026thinsp;0.713\\u003c/em\\u003e)\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eMild atrophy (60\\u0026ndash;80%)\\u003c/b\\u003e: 8.8% vs. 5.3% (\\u003cem\\u003ep\\u0026thinsp;=\\u0026thinsp;0.659\\u003c/em\\u003e)\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eSignificant atrophy (\\u0026lt;\\u0026thinsp;60%)\\u003c/b\\u003e: seen in \\u003cb\\u003eonly 1 patient per group\\u003c/b\\u003e, reflecting equivalent long-term vascular preservation (\\u003cem\\u003ep\\u0026thinsp;=\\u0026thinsp;1.000\\u003c/em\\u003e).\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003cp\\u003eThese findings indicate that both open and laparoscopic second-stage Fowler\\u0026ndash;Stephens orchidopexy achieve \\u003cb\\u003eexcellent long-term testicular viability and volume preservation\\u003c/b\\u003e.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec29\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eCosmetic Outcome\\u003c/h2\\u003e\\u003cp\\u003eCosmetic satisfaction, assessed on a 10-point scale, was \\u003cb\\u003esignificantly higher\\u003c/b\\u003e in the laparoscopic group (\\u003cem\\u003e9.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.8\\u003c/em\\u003e) compared with the open group (\\u003cem\\u003e8.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.2; p\\u0026thinsp;=\\u0026thinsp;0.003\\u003c/em\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe superior cosmetic results are attributable to the smaller incisions and reduced scrotal scarring in the laparoscopic approach.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eReturn to Normal Activities\\u003c/h3\\u003e\\n\\u003cp\\u003eChildren undergoing laparoscopic Stage 2 surgery resumed normal activities \\u003cb\\u003esignificantly earlier\\u003c/b\\u003e than those in the open group:\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003e10.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.4 days\\u003c/b\\u003e vs. \\u003cb\\u003e14.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.2 days\\u003c/b\\u003e (\\u003cem\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/em\\u003e).\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis suggests a smoother postoperative recovery and reduced morbidity with the minimally invasive technique.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eLong-term Follow-up Outcomes\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eParameter\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eGroup A (Open Stage 2) n\\u0026thinsp;=\\u0026thinsp;34*\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eGroup B (Laparoscopic Stage 2) n\\u0026thinsp;=\\u0026thinsp;38*\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ep-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMean follow-up (months)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e24.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.468\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTesticular position\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.894\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDependent scrotal\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e32 (94.1%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e36 (94.7%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMid-scrotal\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2 (5.9%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2 (5.3%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHigh scrotal\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTesticular size preservation\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNormal size (\\u0026gt;\\u0026thinsp;80% of contralateral)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e30 (88.2%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e35 (92.1%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.713\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMild atrophy (60\\u0026ndash;80%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3 (8.8%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2 (5.3%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.659\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSignificant atrophy (\\u0026lt;\\u0026thinsp;60%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1 (2.9%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1 (2.6%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCosmetic satisfaction score (\\u003cspan additionalcitationids=\\\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e8.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e9.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.003\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eReturn to normal activities (days)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e14.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e*Only successful cases included in long-term analysis.\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe pattern of testicular preservation during the follow-up period is shown in Fig.\\u0026nbsp;1.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe cosmetic satisfaction scores between Open Second Stage and Laparoscopic Second Stage Orchidopexy are shown in Fig.\\u0026nbsp;2.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cdiv id=\\\"Sec31\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eCost Analysis\\u003c/h2\\u003e\\u003cp\\u003eTable\\u0026nbsp;6 presents a detailed comparison of the economic implications of open versus laparoscopic second-stage Fowler\\u0026ndash;Stephens orchidopexy. Despite notable differences in individual cost components, the \\u003cb\\u003eoverall treatment cost remained comparable\\u003c/b\\u003e between the two groups.\\u003c/p\\u003e\\u003cp\\u003eThe \\u003cb\\u003eequipment cost per case\\u003c/b\\u003e was significantly higher in the laparoscopic group (4,560\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;420) compared with the open approach (2,840\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;320; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), reflecting the expense of laparoscopic instruments and energy devices. Consequently, the \\u003cb\\u003etotal operative cost\\u003c/b\\u003e was also substantially greater for laparoscopic procedures (11,240\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1,320 vs. 8,640\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;980; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001).\\u003c/p\\u003e\\u003cp\\u003eIn contrast, patients undergoing laparoscopic Stage 2 surgery incurred \\u003cb\\u003esignificantly lower hospital costs\\u003c/b\\u003e (4,280\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;780) compared with those in the open group (6,420\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1,140; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). This reduction is attributable to shorter postoperative recovery times and decreased length of stay associated with the minimally invasive approach.\\u003c/p\\u003e\\u003cp\\u003eInterestingly, when all components were combined, the \\u003cb\\u003etotal treatment cost\\u003c/b\\u003e\\u0026mdash;encompassing operative, equipment, and hospital expenditures\\u0026mdash;did not differ significantly between groups (15,520\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1,580 for laparoscopic vs. 15,060\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1,680 for open; \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.198). This demonstrates that despite higher operative expenses, the cost savings resulting from shorter hospitalization offset much of the additional laparoscopic expenditure.\\u003c/p\\u003e\\u003cp\\u003eOverall, these findings indicate that while the laparoscopic technique is more expensive intraoperatively, its associated reductions in postoperative care requirements produce a \\u003cb\\u003ecost-neutral overall outcome\\u003c/b\\u003e compared with the open approach.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 6\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eCost Comparison (in local currency)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCost Component\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eGroup A (Open Stage 2)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eGroup B (Laparoscopic Stage 2)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ep-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEquipment cost per case\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2,840\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;320\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4,560\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;420\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTotal operative cost\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e8,640\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;980\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e11,240\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1,320\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHospital cost\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e6,420\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1,140\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4,280\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;780\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTotal treatment cost\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e15,060\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1,680\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e15,520\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1,580\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.198\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec32\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eSubgroup Analysis\\u003c/h2\\u003e\\u003cp\\u003eAnalysis of outcomes based on patient age showed that children younger than 2 years had comparable success rates in both groups (Open: 16/18, 88.9% vs Laparoscopic: 15/16, 93.8%; p\\u0026thinsp;=\\u0026thinsp;0.642). Similarly, no significant difference was observed in bilateral cases, though the sample size was limited (Group A: 1/1, 100% vs Group B: 2/2, 100%), as shown in Fig.\\u0026nbsp;4.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cdiv id=\\\"Sec34\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eSurgical Outcomes and Success Rates\\u003c/h2\\u003e\\u003cp\\u003eThe overall success rate of 91.1% for two-stage Fowler-Stephens orchidopexy in our study compares favorably with reported rates of 85\\u0026ndash;95% in the literature (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). Importantly, we found no statistically significant difference in success rates between open (89.5%) and laparoscopic (92.7%) second-stage approaches, supporting the equivalence of both techniques in achieving the primary objective of successful orchidopexy when preceded by standardized laparoscopic vessel division.\\u003c/p\\u003e\\u003cp\\u003eThe significantly shorter operative times observed in the laparoscopic group for Stage 2 orchidopexy (78.3 vs 94.6 minutes) reflect the enhanced visualization and precision offered by minimally invasive techniques for the second stage (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e). Since Stage 1 was identical for both groups (laparoscopic vessel division), this efficiency advantage is specifically attributable to the laparoscopic approach for testicular mobilization and positioning.\\u003c/p\\u003e\\u003cp\\u003eThe 7.3% conversion rate from laparoscopic to open approach in our series falls within the acceptable range reported in pediatric laparoscopic surgery and primarily occurred due to dense adhesions from previous procedures or technical difficulties in testicular mobilization (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003ePostoperative Recovery and Complications\\u003c/h3\\u003e\\n\\u003cp\\u003eThe laparoscopic approach for Stage 2 demonstrated clear advantages in postoperative recovery, with significantly shorter hospital stays and faster return to normal activities. These findings align with the well-established benefits of minimally invasive surgery and have important implications for healthcare resource utilization and family convenience (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eWhile the overall complication rate was numerically lower in the laparoscopic second-stage group (19.5% vs 31.6%), this difference did not reach statistical significance, likely due to our sample size. The types of complications observed were predominantly minor and comparable between groups, suggesting that both second-stage techniques carry similar safety profiles when performed by experienced surgeons following standardized laparoscopic vessel division.\\u003c/p\\u003e\\n\\u003ch3\\u003eLong-term Outcomes and Testicular Preservation\\u003c/h3\\u003e\\n\\u003cp\\u003eThe comparable rates of testicular size preservation between groups (92.1% laparoscopic vs 88.2% open) support the effectiveness of both approaches in maintaining testicular viability through the staged procedure. This finding is crucial given that testicular atrophy remains the most significant concern with the Fowler-Stephens technique (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe six-month interval between stages, based on established protocols, appears adequate for developing collateral circulation through vasal vessels. Some authors have suggested shorter intervals, but our results support the traditional approach (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cdiv id=\\\"Sec37\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eCosmetic and Functional Considerations\\u003c/h2\\u003e\\u003cp\\u003eThe significantly superior cosmetic satisfaction scores in the laparoscopic group (9.1 vs 8.4) reflect the reduced scarring associated with minimally invasive approaches. While this difference may appear modest, cosmetic outcomes are increasingly important to families and can impact long-term psychological well-being in these children.\\u003c/p\\u003e\\u003cp\\u003eLong-term fertility assessment was beyond the scope of this study but remains a critical endpoint for future research. The preservation of testicular size and position achieved in both groups provides an encouraging foundation for reproductive potential, though hormonal and semen analysis in adolescence will be necessary to definitively assess fertility outcomes (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cdiv id=\\\"Sec38\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003eCost Considerations\\u003c/h2\\u003e\\u003cp\\u003eOur cost analysis revealed that while laparoscopic procedures incurred higher equipment and operative costs, the reduced hospital stay partially offset these expenses, resulting in comparable total treatment costs. This economic equivalence, combined with the clinical advantages of laparoscopy, supports its preferential use when expertise is available.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec39\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eLimitations and Future Directions\\u003c/h2\\u003e\\u003cp\\u003eSeveral limitations warrant acknowledgment. The relatively short follow-up period (mean 24.8 months) precludes assessment of long-term fertility and malignancy outcomes. Additionally, the single-center design may limit generalizability, though our experience likely reflects that of other tertiary centers managing similar case volumes.\\u003c/p\\u003e\\u003cp\\u003eFuture research should focus on longer-term follow-up studies evaluating hormonal function, fertility potential, and psychological outcomes. Comparative studies examining single-stage versus two-stage approaches in appropriately selected cases may also provide valuable insights for optimizing treatment algorithms.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec40\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003eClinical Implications\\u003c/h2\\u003e\\u003cp\\u003eOur results suggest that laparoscopic second-stage orchidopexy should be considered the preferred approach for managing viable intra-abdominal testes when surgical expertise is available, following standardized laparoscopic vessel division. The technique offers comparable success rates to open second-stage surgery while providing advantages in operative efficiency, recovery time, and cosmetic outcomes.\\u003c/p\\u003e\\u003cp\\u003eFor centers with limited laparoscopic experience, open second-stage orchidopexy following laparoscopic vessel division remains a viable and effective option with excellent success rates. The key to optimal outcomes lies in appropriate case selection, meticulous surgical technique for both stages, and comprehensive long-term follow-up regardless of the chosen second-stage approach.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eIn conclusion, both open and laparoscopic two-stage Fowler-Stephens orchidopexy represent effective treatments for nonpalpable undescended testes. The choice between techniques should be guided by the surgical expertise, institutional resources, and patient-specific factors, with the understanding that both approaches can achieve excellent clinical outcomes when performed by experienced pediatric surgeons.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study protocol was submitted and approved by the Institutional Ethics Committee (IEC-SKIMS). Appropriate Written Informed Consent was obtained from the parents and/or guardians of all participating patients.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and material:\\u0026nbsp;\\u003c/strong\\u003eThe datasets used and/or analyzed during the study has been provided in the main manuscript and is also available with the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting of Interests:\\u0026nbsp;\\u003c/strong\\u003eThe authors declare no competing interests.\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSource of funding:\\u0026nbsp;\\u003c/strong\\u003eNo external source of funding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contribution statement:\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eFAN, MAG, UN, GNM, AAB and NAB: Conceptualization, Data Curation, Formal analysis, Funding acquisition, Investigation, Methodology, Projection administration, Resources, Software, Supervision, Validation, Visualization, Writing- original draft, Writing- review and editing. All authors approved the final manuscript for publication.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eKolon TF, Herndon CD, Baker LA et al (2014) Evaluation and treatment of cryptorchidism: AUA guideline. J Urol 192(2):337\\u0026ndash;345\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHutson JM, Balic A, Nation T, Southwell B, Cryptorchidism (2010) Semin Pediatr Surg 19(3):215\\u0026ndash;224\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eTasian GE, Copp HL, Baskin LS (2011) Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness. J Pediatr Urol 7(1):75\\u0026ndash;82\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eElder JS (2001) Cryptorchidism: isolated and associated with other genitourinary defects. Pediatr Clin North Am 48(6):1479\\u0026ndash;1494\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWood HM, Elder JS (2009) Cryptorchidism and testicular cancer: separating fact from fiction. J Urol 181(2):452\\u0026ndash;461\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eForesta C, Zuccarello D, Garolla A, Ferlin A (2008) Role of hormones, genes, and environment in human cryptorchidism. Endocr Rev 29(5):560\\u0026ndash;580\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDieckmann KP, Pichlmeier U (2004) Clinical epidemiology of testicular germ cell tumors. World J Urol 22(1):2\\u0026ndash;14\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRitz\\u0026eacute;n EM, Bergh A, Bjerknes R, Christiansen P et al (2007) Nordic consensus on treatment of undescended testes. Acta Paediatr 96(5):638\\u0026ndash;643\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eEsposito C, Caldamone AA, Settimi A, El-Ghoneimi A (2008) Management of boys with nonpalpable undescended testis. Nat Clin Pract Urol 5(5):252\\u0026ndash;260\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBaker LA, Docimo SG, Surer I et al (2001) A multi-institutional analysis of laparoscopic orchidopexy. BJU Int 87(6):484\\u0026ndash;489\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eFowler R, Stephens FD (1959) The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Z J Surg 29(2):92\\u0026ndash;106\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLindgren BW, Darby EC, Faiella L et al (1998) Laparoscopic orchiopexy: procedure of choice for the nonpalpable testis? J Urol 159(6):2132\\u0026ndash;2135\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eEsposito C, Vallasciani S, Settimi A et al (2004) Current indications and results of laparoscopic orchiopexy for cryptorchid testis. Surg Endosc 18(7):1090\\u0026ndash;1094\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMouriquand PD, Persad R, Sharma S (1998) The undescended testis: current concepts and controversies. Pediatr Surg Int 13(5\\u0026ndash;6):367\\u0026ndash;372\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDocimo SG (1996) Testicular descent and ascent in the first year of life. Urology 48(3):458\\u0026ndash;460\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eEsposito C, Escolino M, Turra F et al (2016) Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg 25(4):232\\u0026ndash;240\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eJordan GH, Winslow BH (1993) Laparoendoscopic upper pole nephrectomy with ureterectomy. J Urol 150(3):940\\u0026ndash;943\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLee PA, Houk CP, Cryptorchidism (2013) Curr Opin Endocrinol Diabetes Obes 20(3):210\\u0026ndash;216\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Undescended testis, Nonpalpable testis, Fowler-Stephens orchidopexy, Laparoscopy\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8126362/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8126362/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003eThe optimal approach for second-stage Fowler\\u0026ndash;Stephens orchidopexy (FSO) in nonpalpable undescended testes remains controversial. While laparoscopy offers superior magnification and minimal invasiveness, the open approach is time-tested and widely practiced. This prospective randomized study compares outcomes of open and laparoscopic second-stage FSO to determine the better approach in terms of testicular viability and surgical success.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eA prospective randomized study was conducted on 105 children with nonpalpable undescended testes. Patients were randomized into Group A (open group, n\\u0026thinsp;=\\u0026thinsp;52) and Group B (laparoscopic group, n\\u0026thinsp;=\\u0026thinsp;53). Both groups underwent diagnostic laparoscopy followed by laparoscopic vessel division in Stage 1. Only viable intra-abdominal testes proceeded to second-stage orchidopexy\\u0026mdash;38 of 52 in Group A and 41 of 53 in Group B. Primary outcomes included success rate and testicular viability, while secondary outcomes assessed operative time, complications, hospital stay, and cosmetic satisfaction.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eThe mean age at surgery was 3.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.1 years. Stage-1 operative times were similar between groups (45.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.1 vs. 44.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.9 minutes). The overall success rate was 91.1%, with no significant difference between the open and laparoscopic groups (89.5% vs. 92.7%, p\\u0026thinsp;=\\u0026thinsp;0.719). The laparoscopic second stage demonstrated significantly shorter operative time (78.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.7 vs. 94.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.2 minutes, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05), reduced hospital stay (2.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.7 vs. 3.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.1 days, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01), and higher cosmetic satisfaction scores (9.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.8 vs. 8.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.2, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Complication rates were comparable (19.5% laparoscopic vs. 31.6% open, p\\u0026thinsp;=\\u0026thinsp;0.278). At a mean follow-up of 24.8 months, 94.4% of testes were in a dependent scrotal position, and 90.3% maintained normal size.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e\\u003cp\\u003eBoth open and laparoscopic second-stage Fowler\\u0026ndash;Stephens orchidopexy provide excellent outcomes in the management of nonpalpable undescended testes. Although overall success and viability rates are equivalent, the laparoscopic approach offers advantages of shorter operative time, reduced hospital stay, and superior cosmetic results. The choice of technique should be guided by surgeon expertise and institutional resources.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Prospective Evaluation of Laparoscopic and Open Second-Stage Fowler–Stephens Orchidopexy: Is Minimally Invasive Surgery Superior?\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-12-01 06:57:06\",\"doi\":\"10.21203/rs.3.rs-8126362/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"96e6262d-7810-442f-b9d8-ff2765b8228f\",\"owner\":[],\"postedDate\":\"December 1st, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-12-29T16:00:09+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-8126362\",\"link\":\"https://doi.org/10.1007/s42804-025-00299-3\",\"journal\":{\"identity\":\"journal-of-pediatric-endoscopic-surgery\",\"isVorOnly\":false,\"title\":\"Journal of Pediatric Endoscopic Surgery\"},\"publishedOn\":\"2025-12-22 15:57:02\",\"publishedOnDateReadable\":\"December 22nd, 2025\"},\"versionCreatedAt\":\"2025-12-01 06:57:06\",\"video\":\"\",\"vorDoi\":\"10.1007/s42804-025-00299-3\",\"vorDoiUrl\":\"https://doi.org/10.1007/s42804-025-00299-3\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8126362\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8126362\",\"identity\":\"rs-8126362\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}