Undescended Testicle (Orchiopexy) Repair Surgery

In the mother’s womb, a baby boy’s testicles develop inside his abdomen. Shortly before birth, they move down into the scrotum. In about 4 percent of infant boys, this movement does not occur. For half of these babies, movement does occur before age 1. If the testicles do not move down into the scrotum by age 1, the pediatrician and parents must discuss whether or not to use surgery, called an orchiopexy (OR-kee-o-PEK-see), to bring the testicles down into the scrotum.

Undescended testicles may not cause pain, but they may cause swelling or a lump in the groin area (the place where the lower abdomen meets the inner thigh). If not corrected surgically, the undescended testicles may cause infertility and other medical problems later in life, including the development of tumors or hernias. The area is also more vulnerable to injury if not corrected.

The surgery to move the undescended testicle into the scrotum is done under general anesthesia. General anesthesia makes your child’s whole body go to sleep and is needed for the surgery so that his reflexes will be completely relaxed. General anesthesia makes the surgery easier and safer to do because your child will not feel any pain or have any memory of it.

Caudal anesthesia is given with general anesthesia to block pain in the low back, tummy and lower trunk area and provides up to 4 hours of pain relief in that area after the surgery. Caudal anesthesia is usually more successful in younger children. The surgeon may give your child a local anesthetic injection if a caudal injection is unsuccessful or unnecessary.

Once your child has been registered, he will be taken to a “holding area” where you will meet the anesthesiologist and your surgeon. A peditric anesthesiologist—a doctor who specializes in anesthesia for children—will give the medications that will make your child sleep during the surgery. At this time, you will be able to ask any questions about the surgery.

Once questions are answered and the operating room is prepared, your child will be taken into the operating room and given an anesthetic to make him go to sleep.

When your child is asleep, the surgery will begin.

• During the procedure, the surgeon will make a small incision (cut) in the groin and locate the testicle.
• He or she will examine the testicle to make sure it is healthy. 
• Commonly, there is a hernia sac (a pouch containing tissue that is “pushed out” from the abdomen) in this area that has to be repaired first.
• Next, he or she will make a second incision in the scrotum to make a “pocket” under the scrotal skin and place the testicle into the scrotum.
• Once the procedure is complete, the surgeon will close both incisions with dissolvable sutures (SOO-chers) or stitches that will dissolve on their own.

When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your child’s surgery, you will receive a phone call from a nurse between the hours of 1 and 9 p.m. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions.

The nurse will give you specific eating and drinking instructions for your child based on your child’s age. Following are the usual instructions given for eating and drinking. No matter what age your child is, you should follow the specific instructions given to you on the phone by the nurse. 

For children older than 12 months:

• After midnight the night before the surgery, do not give any solid food or non-clear liquids. That includes milk, formula, juices with pulp, coffee and chewing gum or candy.

For infants under 12 months:

• Up to 6 hours before the scheduled arrival time, formula-fed babies may be given formula. 
• Up to 4 hours before the scheduled arrival time, breastfed babies may nurse.

For all children:

• Up to 2 hours before the scheduled arrival time, give only clear liquids. Clear liquids include water, Pedialyte®, Kool-Aid® and juices you can see through, such as apple or white grape juice. Milk is not a clear liquid.
• In the 2 hours before the scheduled arrival time, give nothing to eat or drink.

Once your child has been registered for the surgery, a member of the anesthesia staff will meet with you to take your child’s vital signs, weight and medical history. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.

• The anesthesiologist will meet with you and your child to review your child’s medical information and decide which kind of sleep medication your child should get.  
• If your child is very scared or upset, the doctor may give a special medication to help him or her relax. This medication is flavored and takes effect in 10 to 15 minutes. 
• If you wish, you may go with your child to the room where the surgery will be done and stay as the sleep medication is given. 
• Younger children will get their sleep medication through a “space mask” that will carry air mixed with medication. Your child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while your child is still awake. 
• Older children may choose between getting their medication through the mask or directly into a vein through an intravenous (IV) line. 
• When your child has fallen asleep, you will be taken to the waiting room. If it has not already been done, an IV will be started so that medication can be given to keep your child sleeping throughout the surgery. 
• After the IV has been placed, your child will be turned onto his side. Your child’s lower back near the spine (the sacral caudal area) will be cleaned and a needle placed under the skin to inject the caudal anesthetic.

While your child is asleep, his heart rate, blood pressure, temperature and blood oxygen level will be checked continuously. Your child might have a breathing tube placed while he is asleep. If a breathing tube is used, your child might have a sore throat after the surgery.

• To keep your child asleep during the surgery, he might be given anesthetic medication by mask, through the IV tube or both. When the surgery is over, the medications will be stopped and your child will begin to wake up.

After surgery, your child will be moved to the recovery room. You will be called so that you can be there as he wakes up.

• Children coming out of anesthesia react in different ways. Your child might cry, be fussy or confused, feel sick to his or her stomach, or vomit. These reactions are normal and will go away as the anesthesia wears off. 
• While your child is in recovery, your surgeon will talk to you about the surgery. That is a good time to ask questions about pain medications, diet and activity.
• When your child is awake enough, he might be given a Popsicle® or “slushy” to drink in the recovery room. Once the anesthesiologist sees that your child can hold down the drink and his pain is controlled, you may go home. That usually takes about 1 hour.

The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm.

• You are encouraged to talk to your child or hold his hand before the surgery, while sleep medication is given and while in recovery. 
• You may bring along a “comfort” item—such as a favorite stuffed animal or “blankie”—for your child to hold before and after the surgery.

After your child is discharged and goes home, he might still be groggy and should take it easy for the day.

Once your child is home, his diet should be restricted to clear liquids, such as water, Gatorade®, Popsicles® or Kool-aid® for a couple of hours to ensure his stomach is settled after the surgery and the car ride home. If your child does well with these liquids, after a couple hours, he may try a light diet of soft foods like applesauce, soup, toast, bananas, rice or hot cereal. He should avoid greasy foods that stay in the stomach for a long time, such as pizza and fast food. Your child may resume a normal diet the next day.

Your child should take Tylenol® or Motrin® 4 hours after the surgery, which will help with discomfort when the anesthesia wears off. Pain medication is rarely needed after 2 days. If your child is over 5 years of age, your surgeon will give you a prescription for Tylenol® with codeine elixir, in the event that your child needs additional pain medication. You do not need to fill this prescription until you see how your child is doing.

• You will be told how to care for your child’s dressing. Your surgeon may recommend an antibiotic ointment, like Neosporin®, to apply over the suture area 2 to 3 times a day.

Bathing

• The incision should not be soaked for about 5 days.
• If your child is in diapers, he will need “wash cloth” baths for 4 to 5 days.
• If your child is toilet trained, he will need wash cloth baths for 4 to 5 days, but may take a quick shower after 2 days. If the cotton dressing gets wet, you may remove it and replace it with a band-aid.

Activity

After the operation, activity needs to be somewhat restricted.

• The surgeon will determine when your child may resume normal activities.
• Your child may return to school as soon as the next day if he feels well, and certainly within 2 or 3 days of the surgery.
• No bike riding for 1 week.
• Participation in contact sports and gym class is not permitted until the follow-up appointment with the surgeon (usually 4 to 6 weeks).
• Swimming is permitted 1 week after surgery (but no “cannon balls” or belly flops).

If you notice a fever higher than 101.4˚F, bleeding or foul smelling drainage from the area around the incision, call the doctor who did the surgery right away. Also call the doctor if your child has:

• Increased tenderness near the incision.
• Increased swelling or redness near the incision.
• Increased pain that is unexplained.
• Nausea, vomiting, diarrhea or constipation that is not improving.

Your child will have a follow-up visit with the surgeon about 4 to 6 weeks after the surgery.

If you have any specific questions about your child’s surgery, you should discuss them with the surgeon before the surgery. You may call the Division of Pediatric Surgery at Children’s and ask to speak with your child’s surgeon, or speak with him or her during the pre-surgical examination on the day of the surgery.

If your child has any special needs or health issues you feel the doctor needs to know about, please call the Division of Pediatric Surgery at Children’s before the surgery and ask to speak with a nurse. It is important to notify us in advance about any special needs your child might have.