A comparative meta-analysis and systematic review of gubernaculum sparing versus gubernaculum excision orchidopexy.
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BACKGROUND: Cryptorchidism is one of the most common congenital abnormalities and it is associated with impaired fertility, increased malignancy risk, and testicular atrophy. Orchidopexy is the standard treatment for intra-abdominal testes, but the optimal surgical approach remains debated, particularly regarding the role of gubernacular sparing. OBJECTIVES: To compare gubernaculum-sparing and gubernaculum-excision orchidopexy for abdominal cryptorchidism in pediatric patients, focusing on postoperative testicular atrophy rates. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines and registered in PROSPERO. A comprehensive search was performed in PubMed, Embase, Cochrane Library, and Web of Science for studies published up to February 2025. Eligible studies compared gubernaculum-sparing orchidopexy (GS) and gubernaculum-excision orchidopexy (GE) in patients with intra-abdominal testis. The primary endpoint was testicular atrophy rate, and secondary outcomes included postoperative testicular growth. RESULTS: Three studies, including 195 patients, met the inclusion criteria. No significant baseline difference in testis size was observed (MD = -41.3 mm3; 95% CI -192.9-110.4). The pooled analysis showed significantly lower atrophy rates with gubernaculum-sparing orchidopexy versus excision (OR = 0.07; 95% CI 0.01-0.91; I2= 80.8%; p = 0.0225). No significant differences in testis size were found at 3 months (MD = 11.7 mm3; 95% CI -45.9-69.4) or 6 months (MD = 0.4 mm3; 95% CI -52.7-53.5), with negligible heterogeneity (I2= 0%). All included studies were rated as low-to-moderate risk of bias. CONCLUSIONS: This systematic review and meta-analysis demonstrated that gubernaculum sparing during laparoscopic orchidopexy for intra-abdominal testis is associated with lower testicular atrophy rates and comparable postoperative testicular growth. These findings suggest that maintaining gubernacular integrity may help preserve collateral blood supply and optimize testicular viability.