Crossover transseptal vasovasostomy: alternative for very selected cases of iatrogenic injury to vas deferens

ABSTRACT Inguinal herniorraphy is a possible cause of iatrogenic seminal tract obstruction. Diagnosing and correcting these vasal injuries can be challenging. Successful re-anastomosis is technically challenging, with relatively low success rates. An uncommon alternative for selected cases is the crossover transseptal vasovasostomy. We herein report a case of a 36-year-old male patient with vas deferens injury after herniorraphy and a contralateral hypotrophic testis. He was successfully treated through microsurgical crossover transseptal vasovasostomy, with spontaneous pregnancy achieved, and the technique is presented in details.

摘要
腹股沟疝修补术（inguinal herniorrhaphy）是医源性精道梗阻（iatrogenic seminal tract obstruction）的潜在诱因之一。对这类输精管损伤（vasal injuries）进行诊断与修复均颇具挑战。成功实施输精管再吻合术（re-anastomosis）的技术难度较高，且成功率相对偏低。针对特定病例，可采用一种少见的替代术式：交叉隔道输精管吻合术（crossover transseptal vasovasostomy）。本文报告1例36岁男性患者，该患者于疝修补术后出现输精管损伤，且合并对侧睾丸发育不良（contralateral hypotrophic testis）。患者通过显微外科交叉隔道输精管吻合术成功治愈，术后实现自然妊娠，本文亦对该手术技术进行了详细阐述。