Machen G Luke, Mahmoud Ali M, Kleinguetl Colin E, Chen Wencong, Harris Stephanie E, Bird Erin T
Division of Urology, Department of Surgery, Scott and White Medical Center/Texas A&M College of MedicineTempleTexas.
University of Texas Medical BranchGalvestonTexas.
Proc (Bayl Univ Med Cent). 2019 Mar 20;32(2):196-198. doi: 10.1080/08998280.2018.1548839. eCollection 2019 Apr.
Over 500,000 men in America have a vasectomy annually; 2% to 6% of these individuals later elect to have a vasectomy reversal. Vasovasostomies are typically performed using a single- or double-layer closure, with no demonstrated difference between the two in terms of success rates. In 2005, Ho et al described a microscopic technique in which three full-thickness sutures are used and the anastomosis is reinforced with fibrin glue. At our institution, a similar technique has been used for >10 years. To describe our experience, a retrospective chart review was undertaken. Patient demographic information and operative characteristics were analyzed. In each case, fibrin glue was circumferentially applied to reinforce the anastomosis. The overall patency rate was 88.4%, and rates comparing individuals who had their vasectomy reversal within 10 years of vasectomy reached statistical significance with an odds ratio of 2.91 ( = 0.048). Median operative time was 94 minutes. Other demographic variables analyzed did not have a correlation with patency. In conclusion, our technique provides acceptable patency rates, especially with obstructive intervals of 10 years or less, while likely resulting in cost savings given the decreased operating room time and suture used.
美国每年有超过50万名男性接受输精管切除术;其中2%至6%的人后来选择进行输精管复通术。输精管吻合术通常采用单层或双层缝合,两者成功率并无显著差异。2005年,Ho等人描述了一种显微技术,该技术使用三根全层缝线,并使用纤维蛋白胶加强吻合。在我们机构,类似技术已使用超过10年。为描述我们的经验,我们进行了一项回顾性病历审查。分析了患者的人口统计学信息和手术特征。在每种情况下,均在吻合口周围应用纤维蛋白胶以加强吻合。总体通畅率为88.4%,输精管切除术后10年内进行输精管复通术的患者的通畅率相比达到统计学显著性,优势比为2.91(P = 0.048)。中位手术时间为94分钟。分析的其他人口统计学变量与通畅率无相关性。总之,我们的技术提供了可接受的通畅率,尤其是在梗阻时间为10年或更短的情况下,同时由于减少了手术室时间和缝线使用,可能节省成本。