The surgery of vasectomy reversal
Pre-operative preparation
Following consultation and consideration of the benefits, disadvantages, complications and pregnancy rates of vasectomy reversal, we will arrange admission to hospital. You should inform our anaesthetist of any past or present medical problems, medications you are taking and of any allergies. You should not have anything to eat or drink from the evening before your surgery.
Skin incision
To perform a vasectomy reversal two incisions of about 2.5cm are are made on either side of the scrotum above the testes. These permit access to the scrotal contents including the vas deferens, testes and epididymus.
Scrotal exploration
This involves manually identifying the structures of the scrotum, in particular making note of the vas deferens and the site of the previous vasectomy. The amount of vas deferens which is absent or damaged is assessed along with the available length remaining for re-anastomosis. Occasional so much vas deferens has been damaged that it is necessary to consider a different surgical technique called microsurgical vaso-epididymostomy. Provided that the anatomy remains acceptable and there is sufficient vas deferens remaining a decision is made to proceed to dissecting the vas deferens for reversal.
Dissection of the Vas Deferens
Following exploration to assess suitability for reversal (which is almost always possible), the vas deferens is then dissected free of the surrounding tissue. The area of the prior vasectomy usually remains adherent within scar tissue - it is however universally possible to identify normal vas deferens on either side of the vasectomy site. Having freed the vas deferens it is then cut on either side of the vasectomy site so that a normal open tube is available for re-anastomosis of each end.
Microsurgical re-anastomosis
The cut ends of the vas deferens are brought into close proximity with each other and stabilized in position by a small atraumatic clip. An operating microscope is then used to magnify the site of the microsurgery approximately 40 times. A series of very fine microscopic sutures (much finer than a human hair) are then placed around the circumference of the lumen of the vas deferens (which is less in diameter of a pin) to bring the ends together and establish patency (microsurgical vaso-vasostomy). Once this has been achieved a second layer of sutures is then added to provide support and stability to the site of the anastomosis. These secondary sutures reduce the risk of movement and therefore excess scarring following the operation. It is always possible to visibly see the ends of the vas deferens come together and be certain at the time of the surgery that the vas deferens is open.
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When microsurgical epididymostomy is necessary the vas deferens is attached to the epididymus by a series of circumferential sutures which are even finer than those used for vaso-vasostomy.
Closure
Once the microsurgery is finished the scrotum is closed in two layers: the first an inner continuous suture to bring the subcutaneous tissues together, and then the skin edges are brought together and closed by a series of very fine interrupted stitches. So that accumulating fluid does not place tension on the site of the anastomosis a small soft drain is placed. It is removed the next morning.