Terminoterminal anastomosis of the vas deferens. Comparison of microsurgical technics

Traditional surgical therapy for the sterility-causing afflictions of the deferens has produced poor results. Recently however the adoption of microsurgical techniques and the use of an operating microscope (ideal for small structures) have considerably increased the number of positively resolved cases. The greatest successes have been obtained in the reversal of vasectomies the resectioning of stenotical segments and the reconstruction of the continuity of the deferens. Presently the goal is to examine the various techniques of microsurgical vaso-vasostomy adopted by the various authors to obtain a more complete continuity and reimpermeability of the anastomosis of the deferens. Of the microsurgical techniques for deferential anastomosis; the Silber technique involves a double muco-mucosa and muscular layer. The Hamidinia technique involves tying off the 5th suture and cutting it so that the deferential opening is still visible before the final suture is tied off. With the Jenkins and Blacklock technique a 21-guage hypodermic needle is inserted into the deferential opening in the direction of the epididymis and brought out of the wall at .5 cm. The Willscher and Novicki technique uses a plexiglas stabilizer; the ends of deferens are brought together and then sutured. The Arnold and Belker technique uses a foldable clamp which brings the 2 ends together. In the Microsurgery Department of the 3rd Surgical Clinic of La Sapienza University in Rome a 2-layer deferento-deferential technique derived from Silber is used. An attempt is made to save the deferential artery dissecting it from the deferens by about 1 cm and performing an accurate hemostasis with a bipolar scalpel. A clamp is used for the 2 ends. The procedure begins by suturing the mucosa in its frontal position inserting a triple strand of thread that is then sectioned in such a way that the strands can be tied off as if they related to 3 separate points. Although the results of the technique have been very positive it is felt that there is still much room for improvement.