Microsurgical Vasovasostomy: One-Layer vs. Two-Layer

Although vasectomy should be considered a permanent form of birth control, around 6 percent of men will eventually decide to undergo a vasectomy reversal. This procedure is done to restore a man’s fertility and allow him to father a child through natural means.

One method for reversing a vasectomy is a vasovasostomy. During this surgical procedure, the two cut ends of the vas deferens are sewn back together using very fine sutures viewed through a powerful surgical microscope. If successful, this procedure will enable sperm to flow from the testicles once again.

Several surgical techniques exist for rejoining the vas deferens. Some work better than others, but the best results are always obtained by doctors with training in microsurgical reconstruction. One of these methods is known as a two-layer vasovasostomy.

Two-layer vasovasostomy

The vas deferens is a hollow tube that carries sperm from the testicles. This tube is cut in half during a vasectomy, leaving two closed ends of the tube. One way to restore a man’s fertility is to rejoin those two ends using a procedure known as a microsurgical two-layer vasovasostomy.

First, the ends of the vas deferens are cut using a scalpel to form two open tubes. At this time, the surgeon examines the part of the vas deferens coming from the testicle to see if there is fluid present. If there is no fluid, the surgeon decides whether to do another type of vasectomy reversal known as an epididymovasostomy.

The wall of the vas deferens has several layers of tissue, including an inner mucosa layer and an outer seromuscular layer. In the two-layer technique, each of the layers on one severed end of the vas deferens is joined with the corresponding layer on the other severed end. This forms an intact tube.

Over time, the sutured layers heal to form the walls of the rejoined vas deferens. It is important that the severed ends are connected properly in order to create a watertight seal. This prevents scar tissue from forming, which can block the vas deferens and reduce fertility.

This technique requires more microsurgical training than other techniques, but it doctors think this does a better job of keeping the vas deferens open, and prevent fluid from leaking into or out of the vas deferens at the suture site.

One-layer vs. two-layer vasovasostomy

The one-layer technique is a relatively simpler and faster procedure, compared to the two-layer technique. This method, though, may not work well if the central opening of each cut end of the vas deferens is a different size.

The basic one-layer technique uses sutures to bring all layers of the vas deferens together. However a modified one-layer technique uses an extra layer of sutures in the seromuscular layer. As with the two-layer technique, this also requires formal microsurgical training.

Effectiveness of a vasectomy reversal is measured by whether sperm shows up in the ejaculate after the procedure and whether the couple is able to get pregnant.

Some studies have shown that the two-layer technique is just as effective as a modified one-layer technique. In all cases, though, effectiveness depends on a surgeon’s training and experience in the microsurgical technique for a specific procedure.

Updated July 18, 2016

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