A REVEIW OF OCCLUSION TECHNIQUES
The success rates achieved with vasectomy are related largely to the various techniques used to occlude the vas deferens. The success rates vary, but generally the best results are achieved when cautery and/or fascial interposition are used.
Ligation and Excision
Failure rates reported in the literature ranging from 1.5 to 29%[1]
This procedure is perhaps the classic vasectomy technique. A segment of vas is removed followed by the ligation of each severed stump with sutures or metallic clips. No cautery or fascial interposition
Ligation and Fascial Interposition
Failure rates reported in the literature as high as 16.7% [2]
Similar to the classic procedure of excision and ligation but including fascial interposition; the process of separating the two severed ends of the vas by the vasal sheath. Typically the abdominal end is sewn into the sheath and the testicular end is left outside the sheath.
Cautery and Excision
Failure rates reported in the literature as high as 4.8%[3]
A segment of vas is removed and the inner lumins of the two vas stumps are cauterized. No other occlusive measure (i.e. ligation) are employed.
Cautery and Fascial Interposition
Failure rates reported in the literature as high as 1.2%[4]
The vas is transected and the inner lumins cauterized combined with fascial interposition with the testicular-end sewn inside the vasal sheath.
Cautery and Facial Interposition (open testicular end)
Failure rates reported in the literature ranging from 0.02% to 2.4%[5]
A segment is removed and the inner lumin of the abdominal end is cauterized and sewn inside the vasal sheath. The testicular end is left open and un-occluded and outside the sheath.
Intraluminal Cautery
Failure rates reported in the literature less than 1%[6]
No excision or transaction of the vas, instead a cautery needle is used to cauterize in both directions from the apex of the exposed vas loop.
 
Highlights from a highly informative paper entitled; “Vasectomy Surgical Techniques: a systematic review” by Michael Labrecque, Mark Barone and colleagues[7] follows:
The occlusive value of Folding back the vas when ligating
The risk of occlusive failure without folding back 0% to 29.1% while the failure rates with folding back ranged from 0% to 3.7% However the authors of this systematic review concluded that the quality of the studies reporting these figures made it impossible to draw conclusions as to the value of the technique.
The occlusive value of Fascial Interposition
Studies where Fascial Interposition was not used reported failure rates ranging from 1.4% to 29.1%. Failure rates when Fascial Interposition was used ranged from 0% to 16.7%
The occlusive value of Cautery
Studies using no cautery and only ligation reported failure rates ranging from 0.4% to 29.1% and when cautery was used, failure rates ranged from 0% to 4.8%.
Complication risks associated with open-ended technique.
97% granuloma rate vs. 4% of closed-end patients. Painful granuloma risk ranged from 0.8% to 1.5% with open-end and 0.8% to 3.2% with closed end
The risk of epididymitis with open-end technique ranged from 0% tyo 4% and with closed-end technique from 0.1% to 6%.
It was concluded that an open-end technique provides substantially equivalent effectiveness as long as the prostatic end is closed with fascial interposition and cautery.
[1] Chen-Mok et al. Control Clin Trials 2003;24:78-84 | Barone et al. J Urol 2003;170:892-6
[2] Sokal et al. BMC Urol 2004;4-12 | Chen-Mok et al. Control Clin Trials 2003;24:78-84
[3] Aradhya et al. BMJ 2005;330:296-9
[4] Aradhya et al. BMJ 2005;330:296-9 | Sokal et al. BMC Urol 2004;4-12 
[5] Labrecque et al. J Urol 2002;168:2495-8 | Li et al. Adv Contracept Deliv Syst 1994;10:153-9
[6] Marie Stopes International www.mariestopes.com.au/resource_center
[7] Labrecque et al. BMC 2004,2:21;5

 
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