There are 2 ways to do a vasectomy reversal: the one layer anatomosis and the 2 layer technique. Either way is fine as long as the anastomosis (re-connection) is water-tight and tension free and the 2 ends of the vas deferens are placed perfectly together. I can employ either technique and choose one depending on the findings at the time your surgery.
In a straightforward vasectomy reversal, the length of missing segment will be short and there will be sperm in the vasal fluid. In this instance, a vaso-vaso—or V-V—can be performed with success rates in the 90% range, or higher. In some circumstances, intra-operative inspection of the vasal fluid will indicate that you have a condition known as “blow-out.” Blow-out, in medical terms, is caused by an obstruction at the level of the epididymis. The presence of blow-out requires that I perform an epididymo-vasostomy—or E-V—in order to ensure the highest chances of success for you.
Very few surgeons have the training or expertise to successfully perform an E-V. E-Vs require that the surgeon operate at high magnification and use sutures too small to see with the naked eye. The sutures must be placed perfectly or the procedure will simply not work. While in most operations, “good enough” is sufficient, an E-V requires perfection; nothing less.
The vasectomy reversal is best performed under the aid of a high power, operating microscope. The use of “loupes”, which are low cost magnifying glasses, is not sufficient. Only operating microscopes that have high power magnification, electronic motion, focus, and zoom controls, and vibration dampening are sufficient for vasectomy reversals.