Whether a surgeon is reversing a vasectomy or repairing a blockage in the vas deferens occurring from other causes, similar techniques of microsurgery are used. The operation is called a vasovasostomy. It is usually performed in an outpatient setting, so that men can return home the same day, often within hours after the surgery. Several different types of anesthesia can be used, and patient and surgeon should discuss the options ahead of time to choose the safest and most effective one for their particular circumstances. With general anesthesia, the patient is completely unconscious. A regional anesthetic leaves the patient awake, but uses anesthesia placed around the spinal column, numbing the patient from the waist down. A local anesthetic is a third option, injecting an anesthetic drug with a fine needle directly into the area of the surgery to numb the tissue. Often, sedative drugs are given along with the local anesthesia to make the patient comfortable and fully relaxed.
Vasovasostomy involves making an incision in the scrotum just large enough to allow the surgeon to find the vas deferens and identify the blocked area or the site of the previous vasectomy. The vas deferens is a muscular tube with a diameter of about 1/8 inch. In its middle, a tiny channel forms the sperm cells’ highway. The surgeon will remove the scar tissue from both ends of the vas deferens. Two freshly cut ends of the tube are left. The two small openings must be precisely aligned and carefully sewn together without any leaks, and with a technique that should prevent excessive scar tissue from forming during healing. Once sewn together, the vas deferens is placed back into the scrotum and the incision is sewn closed. Sometimes after vasectomy the vas deferens is not the only sperm pathway that is obstructed, and reconnecting its two ends will not remove all the roadblocks in the sperm transport system. Another area of blockage that can occur is in the delicate epididymis, the coiled tube that lies against the testicle where sperm cells mature. This happens more commonly when the vasectomy had been performed many years previously. Over the years, more sperm may be produced than the body can absorb, increasing the pressure inside the epididymis and vas deferens. The result is a blowout much like the leak that occurs in the weakest spot of an over inflated tire. This blowout can only be identified at the time of surgery.
The epididymis may also develop a blockage as a result of infection or injury. Occasionally a man is born with a blockage. Whatever the reason, the surgical procedure to bypass the epididymal blockage remains the same. The epididymis is carefully examined and samples of fluid are taken, first from its most distant end (furthest from the testicle and closest to the vas deferens). If no sperm are found, the tube is sampled again, closer and closer to its top, until sperm are found. This is the site where the end of the vas deferens will be connected to the epididymis.
To bypass the blockage in the epididymis, the surgeon must connect the upper portion of the vas deferens to the correct area of the epididymis itself. This type of surgery is even more technically demanding, because the tubules that make up the epididymis are even smaller and thinner than the vas deferens. The success rate for this type of surgery, called a vasoepididymostomy, depends on several factors, including the experience of the surgeon and the location of the blockage. The closer to the top (or testicle) that the new connection is made, the less mature the sperm will be. Consequently the pregnancy rate will be lower.
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