(502) Laparoscopically Assisted Microsurgical Vasovasostomy for Obstructive Azoospermia Following Bilateral Inguinal Hernia Repair

Introduction Obstructive azoospermia (OA) is an important cause of male infertility. Iatrogenic vas deferens injury after bilateral inguinal hernia repair is uncommon, and outcomes of microsurgical vasovasostomy (VV) in this context are poorly characterized. Objective To evaluate the feasibility, safety, and reproductive outcomes of laparoscopically assisted microsurgical vasovasostomy in patients with obstructive azoospermia secondary to bilateral inguinal hernia repair, and to assess its potential to restore patency and enable natural or assisted conception. Methods We retrospectively reviewed five men with OA after bilateral hernia repair who underwent attempted laparoscopically assisted microsurgical VV. Inclusion criteria were azoospermia on at least two semen analyses, normal serum FSH and testosterone, preserved testicular volume, and female partners without major reproductive comorbidities. We collected demographics, obstruction interval, operative details, complications, postoperative semen parameters, patency (sperm in ejaculate), and reproductive outcomes Results Median patient age was 39 years (range 35–41) and partner age 35 years (30–40). Obstruction intervals were 4–12 years. Four patients underwent laparoscopic dissection with bilateral VV (three two-layer, one one-layer); in one case anastomosis could not be performed. Operative time was 150–420 minutes. One patient reported transient scrotal pain. Patency was achieved in 3 of 4 anastomosed patients (75%), with postoperative sperm concentrations 3.0–41 ×10^6/mL. Four pregnancies occurred: three via assisted reproductive technology (ART) and one spontaneous. ART was required in two non-patent cases and in one patient with restored patency; the spontaneous pregnancy occurred in the patient with the highest postoperative sperm concentration (41×10^6/mL). Conclusions Laparoscopically assisted VV is a safe and effective approach for men with OA after bilateral hernia repair. While ART remains necessary for some, ejaculated sperm can often be used and natural conception is possible when postoperative semen parameters are favorable. Disclosure No