{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:50:59Z","timestamp":1787021459032,"version":"build-2736575974"},"update-to":[{"DOI":"10.12688\/f1000research.141110.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000}}],"reference-count":29,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Background This study performed a systematic review and meta-analysis to compare the outcomes of the staged laparoscopic Fowler-Stephens Laparoscopic Orchiopexy (FSLO) and Staged Laparoscopic Traction Orchiopexy (SLTO) in patients with intra-abdominal testes (IAT). Methods This study reviewed literature published from 2016 to 2024. A systematic literature search was conducted on three databases: PubMed, ScienceDirect, and Google Scholar, using keywords (High intra abdominal testis) AND ((\"Fowler Stephens laparoscopic orchiopexy\" OR (FSLO)) OR (Staged Laparoscopic traction orchiopexy OR (SLTO)). Non-randomized trials and observational studies comparing staged laparoscopic FSLO and SLTO, without any time range restriction are included. Studies without FLSO orchidopexy as a control, case reports, case studies, duplicate publication, no full text and non-English studies are excluded. This study used the PRISMA protocol, the Jadad Scale, and the Newcastle Ottawa Scale (NOS) to evaluate the included studies. To analyze statistical data, the Review Manager (RevMan) software was used. The Chi-squared test was used to calculate statistical heterogeneity in the meta-analysis. Results There were 240 patients from 5 studies (109 in the SLTO group and 131 FSLO in group). The primary outcome of this study is testicular descent and atrophy. There were no significant differences in testicular descent (RR:1.08[0.96 \u2013 1.23],p&lt;0.20,I2:0%) and atrophy rate (RR:0.45[0.19 \u2013 1.09],p&lt;0.08,I2:0%). Secondary outcomes are the duration of operation in both the first and second stages. Statistical analysis reveals a significantly lower first-stage operation time in the FSLO group (MD:9.31[7.08,11.55], p&lt;0.05;I2:94%). At the same time, lower second-stage operation times are significantly reported in the SLTO group (MD:-4.05[-7.99,-0.12],p&lt;0.05; I2:60%). Conclusions In terms of testicular descent and testicular atrophy the SLTO technique yields similar results to the FSLO technique. Both techniques have advantages and disadvantages, and we recommend SLTO as the first choice in children with a high IAT of &lt;4 cm. 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Urol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"611-6","DOI":"10.1111\/j.1651-2227.2007.00241.x","article-title":"Cryptorchidism: Classification, prevalence and long-term consequences.","volume":"96","author":"H Virtanen","year":"2007","journal-title":"Acta Pediatr, Int. J. Pediatr."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"241-248","DOI":"10.1053\/j.sempedsurg.2016.05.007","article-title":"The undescended testis: Clinical management and scientific advances.","volume":"25","author":"J Vikraman","year":"2016 Aug 1","journal-title":"Semin. Pediatr. Surg."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2041-2047","DOI":"10.1016\/j.jpedsurg.2017.11.050","article-title":"A critical review of recent clinical practice guidelines on management of cryptorchidism.","volume":"53","author":"J Kim","year":"2018","journal-title":"J. Pediatr. Surg."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"178-181","DOI":"10.1016\/j.jpurol.2010.04.010","article-title":"Laparoscopic orchiopexy for non-palpable testes: Outcome of two techniques.","volume":"7","author":"E Moursy","year":"2011 Apr","journal-title":"J. Pediatr. Urol."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1327-1330","DOI":"10.1007\/s00383-011-2970-9","article-title":"Laparoscopic management of impalpable testes: Comparison of different techniques.","volume":"27","author":"R Singh","year":"2011 Dec","journal-title":"Pediatr. Surg. Int."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"327-338","DOI":"10.1007\/s00383-015-3676-1","article-title":"What is the ideal surgical approach for intra-abdominal testes? a systematic review.","volume":"31","author":"C Wayne","year":"2015","journal-title":"Pediatr. Surg. Int."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"116-122","DOI":"10.1097\/01.XPS.0000418565.22598.63","article-title":"Laparoscopic classification of the impalpable testis: An update.","volume":"8","author":"A Abouzeid","year":"2012 Oct","journal-title":"Ann. Pediatr. Surg."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"92-106","DOI":"10.1111\/j.1445-2197.1959.tb03826.x","article-title":"the Role of Testicular Vascular Anatomy in the Salvage of High Undescended Testes.","volume":"29","author":"R Fowler","year":"1959","journal-title":"Aust. N. Z. J. Surg."},{"key":"ref10","doi-asserted-by":"crossref","first-page":"402-406","DOI":"10.1055\/s-2008-1039028","article-title":"Laparoscopically assisted gradual controlled traction on the testicular vessels: A new concept in the management of abdominal testis. A preliminary report.","volume":"18","author":"S Shehata","year":"2008 Dec","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"638-643","DOI":"10.1111\/j.1651-2227.2006.00159.x","article-title":"Nordic consensus on treatment of undescended testes.","volume":"96","author":"E Martin Ritz\u00e9n","year":"2007","journal-title":"Acta Pediatr."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"418-426","DOI":"10.1055\/s-0036-1592197","article-title":"Surgical Management of the Undescended Testis: Recent Advances and Controversies.","volume":"26","author":"J Elder","year":"2016 Oct","journal-title":"Eur. J. Pediatr. Surg [Internet]."},{"key":"ref13","article-title":"Bias in meta-analysis detected by a simple, graphical test. Graphical test is itself biased.","volume":"316","author":"L Irwig","year":"2013","journal-title":"BMJ (Clinical Research Ed.)."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"43-51","DOI":"10.1007\/s40746-016-0039-7","article-title":"Current Management of Undescended Testes.","volume":"2","author":"D Kurz","year":"2016 Mar","journal-title":"Curr. Treat Options Pediatr."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"97-103","DOI":"10.1007\/s00383-017-4170-8","article-title":"Evaluation of two-staged Fowler\u2013Stephens laparoscopic orchidopexy (FSLO) for intra-abdominal testes (IAT).","volume":"34","author":"D Bagga","year":"2018","journal-title":"Pediatr. Surg. Int."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"261-266","DOI":"10.4103\/iju.IJU_507_20","article-title":"A comparative study between two techniques of laparoscopic orchiopexy for intra-abdominal testis.","volume":"37","author":"O Bawazir","year":"2021 Jul 1","journal-title":"Indian J Urol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"00046-00049","DOI":"10.1016\/j.jpurol.2024.01.017","article-title":"Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction? A multicentric comparative study.","volume":"S1477-5131","author":"V Bidault-Jourdainne","year":"2024","journal-title":"J. Pediatr. Urol."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1851-1856","DOI":"10.1016\/j.juro.2008.12.003","article-title":"Long-Term Outcome of Laparoscopic Fowler-Stephens Orchiopexy in Boys With Intra-Abdominal Testis.","volume":"181","author":"C Esposito","year":"2009","journal-title":"J. Urol."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"183-185","DOI":"10.1089\/lap.2009.0111","article-title":"Laparoscopic stephen-fowler stage procedure: Appropriate management for high intra-abdominal testes.","volume":"20","author":"A Agrawal","year":"2010","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A."},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.677955","article-title":"Comparison of Two Types of Staged Laparoscopic Orchiopexy for High Intra-Abdominal Testes in Children: A Retrospective Study From a Single Center.","volume":"9","author":"J Liu","year":"2021 Jun 17","journal-title":"Front. Pediatr."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"211-215","DOI":"10.1016\/j.jpedsurg.2015.10.063","article-title":"Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique) Stretching the limits for preservation of testicular vasculature.","volume":"51","author":"S Shehata","year":"2016","journal-title":"J. Pediatr. Surg."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2385-2391","DOI":"10.1016\/j.jpedsurg.2021.02.066","article-title":"Laparoscopic staged management of high intrabdominal testis: A prospective randomized study.","volume":"56","author":"W Dawood","year":"2021 Dec 1","journal-title":"J. Pediatr. Surg."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"351-355","DOI":"10.1016\/j.urology.2022.03.003","article-title":"Modified Traction Technique for Intraabdominal Testes With Short Vessels.","volume":"165","author":"A Aljunaibi","year":"2022","journal-title":"Urology."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"359-361","DOI":"10.1089\/089277902760261383","article-title":"The High Intra-Abdominal Testis: Technique and Long-Term Success of Laparoscopic Testicular Autotransplantation.","volume":"16","author":"L Tackett","year":"2002","journal-title":"J. Endourol."},{"key":"ref25","first-page":"115-125","article-title":"Microvascular autotransplantation of intra-abdominal testes.","volume":"23","author":"P Frey","year":"1989","journal-title":"Prog. Pediatr. Surg [Internet]."},{"key":"ref26","first-page":"290-295","article-title":"Testicular autotransplantation for the intra-abdominal testis.","volume":"16","author":"T Bukowski","year":"1995","journal-title":"Microsurgery [Internet]."},{"key":"ref27","first-page":"555-558","article-title":"Combined laparoscopic and microsurgical techniques for testicular autotransplantation: is this still an evolving technique?","volume":"26","author":"B Kelley","year":"2010","journal-title":"J. Reconstr. Microsurg [Internet]."},{"key":"ref28","first-page":"378-385","article-title":"Gubernaculum Testis and Cremasteric Vessel Preservation during Laparoscopic Orchiopexy for Intra-Abdominal Testes: Effect on Testicular Atrophy Rates.","volume":"201","author":"L Braga","year":"2019 Feb","journal-title":"J. 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We have carefully considered all the comments provided by the editor and reviewers. After several discussion and updates in our research data, here is our responses regarding dr Valeska comments in 2 separate points  \u201dHowever, the small number of patients in each study included weakens the conclusion of this study. For example, only 11 patients with high IAT had STLO in Bawazir and Maghrabi's study. Thus, the conclusion with recommendations for IAT management is criticisable and lacks power. It would be more valuable to open on a larger study needed for high IAT (published recently in JPU 2024).\u201d  Thank you for your guidance, We have included one additional article for analysis, bringing the total to five studies involving 240 patients to strengthen our conclusion in this study and updated our pool data. Our meta-analysis revealed that there was minimal variation and no statistically significant difference in the rate of testicular growth between the STLO and FSLO groups (RR: 1.08; 95% CI: 0.96 \u2013 1.23; p&lt;0.20). Similarly, the rate of testicular atrophy between the STLO and FSLO groups showed low variation and lacked statistical significance (RR: 0.45; 95% CI: 0.19 \u2013 1.09; p&lt;0.08), with low heterogeneity (I2: 0%). In summary, the SLTO technique demonstrated comparable outcomes to the FSLO technique in terms of testicular descent and atrophy. This finding showed the importance for surgeons to make informed decisions based on patient characteristics and their own expertise, as neither technique appears significantly superior regarding testicular descent and atrophy.  \u201cThe objectives are also well exposed, although one may object that duration of each stage for orchiopexy should not be considered, if one technique is superior to the other in terms of testicular descend and atrophy.\u201d  Since the result of our study show that there are no significant differences between both techniques in terms of testicular descent and testicular atrophy, we can conlude that there are no superiority in both techniques. we still need more data regarding the operation time in each stages of procedure to draw conclusion since our result show high heterogenicity mean operation time.  Thank you","URL":"https:\/\/f1000research.com\/articles\/12-1511\/v2#referee-comment-11327","order":2,"name":"referee-comment-11327","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.154524.r241646, Jie Liu, Yijishan Hospital of Wannan Medical College, Wuhu, 08 May 2024, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/12-1511\/v1#referee-response-241646","order":3,"name":"referee-response-241646","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}