Vas reversal, or vasovasostomy, is usually performed utilizing some form of optical magnification. Anesthesia is usually a spinal or general. A vertical scrotal incision is made; and the testis, epididymis, and proximal vas are delivered. The previous vasectomy site is identified and isolated with vessel loops, and this scarred area is then transected sharply on either side and removed so that the two clean-cut ends of the vas can be sewn together. Fluid can be collected from the end closest to the testis; and if microscopic examination confirms the presence of sperm, then this would suggest a better outcome for the restoration of fertility. Once the two ends have had their central openings gently stretched and then patency checked, the two ends of the vas deferens can be placed in a proximator clip to help stabilize the ends of the vas so that they may be joined with very fine 9-0 monofilament nylon suture. A single layer closure is normally performed. The testis, epididymis and cord structures are then returned into the scrotal pouch and the layers closed.
The surgery is usually performed on an outpatient basis. The patient may apply an ice pack to the area and wear a scrotal support and normally avoid heavy lifting and ejaculating for 10-14 days. Follow up sperm counts usually show adequate numbers at about 3 months but with improved motility by about 6 months after vasovasostomy.