Vasoplasty was performed in 40 cases by the flap technique; the patency rate was 79% and the pregnancy rate 34%. The method produced acceptable results almost as good as those achieved by microsurgery but without the need for expensive apparatus and long training.
PIP: The results of 40 cases of vasoplasty, using the flap technique and performed during the past 2-1/2 years are presented. The patients, who ranged in age from 21-40 years, underwent vasovasostomy following the death of children. The interval between vasectomy and vasovasostomy varied from 6 months-10 years. In all cases the vasectomy scar tissue was excised to reveal healthy ends of the vas. The patency of the testicular side of the vas segment was verified by the appearance of seminal fluid. The upper vas segment was dilated with jewellers' forceps and its patency tested by injecting normal saline with the help of a lacrimal cannula. The anastomosis was performed using the Fitzpatrick (1978) flap operation under 2.5 magnification. On average, 6-8 sutures of 8/0 silk were required to complete the anastomosis. 21 patients had bilateral and 19 unilateral anastomoses (11 on the left and 8 on the right side). All patients were given broad spectrum antibiotics and hospitalized for 5-6 days. Semen analysis within the 1st 3 months of follow-up showed return of sperms in 79% of patients, 85% when bilateral, and 72% with unilateral anastomoses. Further follow-up revealed a pregnancy rate of 34%. The major advantages of the flap technique are that stenosis is unlikely at the site of anastomosis, and it can be performed in the stricture prone convoluted segment of the vas. It is cost effective and the technique can be mastered with little experience. In sum, this technique provides a reasonable alternative to the microsurgical method for untrained physicians.