What Microsurgical Technique is best?

There are a variety of microsurgical techniques for connecting the two ends of the vas deferens (the anastamosis).  No one microsurgical technique has been proven to be better than the others.  Two different types of anastamosis have been extensively discussed in the urologic literature:  the two layer technique (first described by Dr. Owen) and the modified two layer technique (first described by Dr. Ira Sharlip as the modified one layer repair).  One of the main differences between the two procedures is this:  during the two layer technique, the inner layer sutures are tied within the wall of the vas deferens (tube), but in the modified two layer anastamosis, the knots of the sutures passing through the inner layer are on the outside of the vas.

At least five studies have shown no difference in results between the two techniques.  The most widely known, The Vasovasostomy Study Group, stated, "The patency and pregnancy rates were no better after 2-layer microsurgical vasovasostomy than after modified 1-layer microsurgical procedures..."

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