The importance of laparoscopy in the surgical reconstruction of inguinal vas injury

vas was too long to anastomose with the proximal end of the vas, or if the distal vas end retreated into the pelvis and was inaccessible at the inguinal area. This procedure is the same as previously reported. 3 If no sperm were found in the fluid from the proximal vas end, a secondary epididymal obstruction was considered, and the modified transverse intussusception vasoepididymostomy (VE), which we previously reported, 3 was performed at the time of the vasovasostomy. Patients started to ejaculate 3 weeks after the reconstructive surgery. Semen analyses were initiated at 1 month, followed by trimonthly (3, 6, 9, and 12 months) semen analyses. We continued following the patients (Table 1) for 12 to 34 months. Of the eight patients, six underwent seminal duct reconstruction surgery, five of these patients had sperm in their ejaculate at follow-up, and two naturally conceived. The sixth patient underwent a unilateral vasovasostomy and epididymostomy at the same time but had no sperm in his ejaculate during the 12-month follow-up. Two of the patients were unable to be reanastomosed due to either atrophic or missing pelvic vas. In seven of the patients with either a long defect of the vas or inability to locate the distal vasal end in the inguinal region, laparoscopic mobilization of the pelvic vas was performed on two patients bilaterally and three patients unilaterally. Another three sides of missing pelvic vas (one bilateral and one unilateral) and one side of atrophic pelvic vas were found laparoscopically. Overall, only three sides of vasovasostomy were directly performed in the inguinal region. Three cases of secondary epididymal obstruction were identified, and two of them underwent ipsilateral VE at the time of VV. The incidence of iatrogenic injury to vas is not infrequent, especially in inguinal surgeries during childhood. 4 Although vasovasostomy for iatrogenic vasal injury is technically more difficult than a vasectomy reversal, it is feasible and worthwhile. 3 The technical difficulty is due to the possible long-segment loss of vas, failure to dissect or find the distal vasal end and secondary epididymis obstruction. A laparoscopic technique is needed to mobilize the pelvic vas and bridge the long defect of vas, 5 and an epididymis obstruction could be repaired using an ipsilateral vasoepididymostomy. 1 It is well-known that microsurgical vasovasostomy is not a technically difficult procedure, and the success rate of a vasectomy reversal is up to 80%–99.5%. 6 Chen et al. …