INTRODUCTION AND OBJECTIVES: In boys with an inguinal testis, the traditional approach is to perform an inguinal incision, open the inguinal canal, mobilize the testis and spermatic cord, repair the inguinal hernia if present, and place the testis in a dartos pouch in the scrotum. In boys, the inguinal canal is short and during inguinal hernia repair, it is often unnecessary to extend the dissection to the internal inguinal ring in order to mobilize enough length. The purpose of this study is to determine if performing a modified inguinal orchiopexy (without opening the inguinal canal) results in a successful orchiopexy. METHODS: Boys with an inguinal testis who underwent orchiopexy were reviewed retrospectively. Patient age and surgical approach (inguinal, with or without inguinal dissection, or prescrotal) were recorded. Only if the testis did not reach the dartos pouch was the inguinal canal opened and a standard orchiopexy performed with inguinal dissection. Presence of an inguinal hernia was also noted. All patients underwent clinical follow-up at 4-6 weeks. Boys with an ectopic, abdominal or absent testis and those undergoing previous inguinal surgery were excluded. RESULTS: A total of 254 boys with 323 undescended inguinal testes were reviewed. The results are shown in Table 1. Overall, 171 underwent a modified inguinal orchiopexy without opening the inguinal canal, 36 underwent inguinal orchiopexy with standard inguinal dissection, and 116 underwent prescrotal orchiopexy. A total of 123 (38.1%) testes were associated with an inguinal hernia that was repaired during orchiopexy. Of those with a hernia, 92 underwent a modified inguinal orchiopexy, 23 underwent a standard inguinal orchiopexy, and 9 were corrected via a prescrotal approach. There was one complication of testicular re-ascent in the modified inguinal orchiopexy group. CONCLUSIONS: In boys with an inguinal undescended testis, orchiopexy can be performed without opening the inguinal canal, even if there is an associated inguinal hernia, with the decision being dependent upon the ability to mobilize the testis and spermatic cord into the dartos pouch. Inguinal (M) Inguinal (S) Prescrotal Total No. testis 171 36 116 323 Mean age (yrs.) 5.1 5.9 4.9 5.1 Hernia 92 (54%) 23 (64%) 9 (8%) 123 (38%) No. side Lt 79 20 56 155 Rt 92 16 60 168 No. complications 1 (0.5%) 0 (0%) 0 (0%) 1 (0.3%) (M) modified, (S) standard