Response to: Laparoscopic versus open orchidopexy for palpable undescended testes: Systematic review and meta-analysis

We read with great interest and much appreciation the recent article published in the Journal of Pediatric Surgery by Mentessi dou et al. [1] on “Laparoscopic versus open orchidopexy for palpa ble undescended testes: Systematic review and meta-analysis”. Undescended testis (UDT) is one of the most common diseases to require surgical intervention in children, but the best approach to be used is still in debate [1,2]. We thank the authors for sys tematically reviewing and comparing open (OO) and laparoscopic (LO) orchidopexy for palpable UDT in a metanalysis, showing no significant difference in success rate, complication occurrence, and operative time, and concluding that LO does not have clear benefits over OO for palpable UTD. The greatest challenge in UDT treatment occurs when we deal with a non-palpable UDT. Although surgical management can range from microsurgical auto transplantation to the scrotal ap proach in these cases, LO and classical OO remain the most used surgical options as well. Reproducing the same principles of OO, vascular preserving LO does not appear to be superior to tradi tional OO, allowing at least equivalent overall success, recurrence, and testicular atrophy rate in boys with a non-palpable UDT [3,4]. First described in 1976, laparoscopy is considered an irreplaceable diagnostic tool in the workup of non -palpable UDT patients. How ever, it does not seem to offer appreciable advantages over OO in the surgical treatment of both palpable and non palpable UDT, and its therapeutic role might be best reserved to those patients with a non palpable high intrabdominal testis where a testicular vascu lature division to gain adequate length could be advantageous