The Combination of Laparoscopic and Microscopic Vasovasostomy for the Treatment of Iatrogenic Upper Vas Deferens Obstruction

Purpose This study aims to evaluate the feasibility and surgical outcomes of laparoscopic and microscopic vasovasostomy for the treatment of iatrogenic upper vas deferens obstruction in the cases of five patients. Materials and Methods A retrospective analysis was conducted on the clinical data of five patients with iatrogenic inguinal vas deferens obstruction. All five patients are male, with an average age of 27.20 ± 1.79 (25–30). All five patients had a history of bilateral indirect inguinal hernia repair during childhood. Open surgical exploration of the original inguinal hernia incision showed the lack of continuity of the vas deferens in all the patients and the existence of obstruction sites in the inner ring opening of the inguinal canal. Laparoscopic surgery was performed to stretch the vas deferens from the outer ring opening of the inguinal canal to the outside of the abdomen. A standard vasovasostomy was then performed microscopically. The reconnected vas deferens was repositioned into the abdomen, with satisfactory placement confirmed via laparoscopic observation. The patency of the vas deferens was confirmed with a methylene blue test, and the posterior abdominal peritoneum was closed. Postoperative follow‐ups were conducted to monitor changes in sperm quality. Results All surgeries on the five patients were successful, among which the vas deferens of three patients were completely ruptured, and those of the other two were partially ruptured with only connections with the epididymis of the vas deferens. The average operation time was 292.0 ± 17.89 (270–320) min. The average follow‐up period was 11.0 ± 3.08 (range 7–15) months. Among the 5 patients, the sperm quality of 4 patients manifested improvement after the operation, while that of the other patient’s condition remained unchanged. Conclusion The combination of laparoscopic and microscopic vasovasostomy is a safe, reliable, and effective surgical technique for treating patients with iatrogenic inguinal vas deferens obstruction.