Prospective Evaluation of Laparoscopic and Open Second-Stage Fowler–Stephens Orchidopexy: Is Minimally Invasive Surgery Superior?

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.