Comparison of modified one-layer and formal two-layer microsurgical vasovasostomy for vasectomy reversal

Background The formal two-layer microsurgical technique is considered the gold standard for vasovasostomy (VV) because of its excellent outcomes; however, it is technically demanding and time-consuming. In this study, we compared the outcomes of modified one-layer and formal two-layer microsurgical VV in men undergoing VV. Results This retrospective analysis included 62 men who underwent bilateral microsurgical VV performed by a single surgeon between 2017 and 2024. The formal two-layer and modified one-layer techniques were performed in 27 and 35 men, respectively. The mean operative time was significantly shorter with the modified one-layer technique than with the formal two-layer technique (118.89 ± 7.99 vs. 152.52 ± 9.31 min, P < 0.001). Patency rates (91.43% [32/35] vs. 92.59% [25/27], P = 0.448) and pregnancy rates (34.29% [12/35] vs. 37.04% [10/27], P = 0.822) were comparable between the two groups. Postoperative sperm concentration and motility did not differ between the two groups. No complications and postoperative reobstruction were observed in either group. Conclusions Compared with formal two-layer microsurgical VV, the modified one-layer technique achieved comparable patency and pregnancy rates while reducing technical difficulty and operative time. It may therefore represent an alternative surgical approach with potential clinical benefits for VV.