When performing a vasectomy with cautery combined with fascial interposition, is it preferable to use dissolving sutures or a clip?
According to vasectomie.net/Vasectomy_AUA_guideline.pdf:
The panel does not advocate the omission of FI (fascial interposition) in performing open ended vasectomy with MC (mucosal cautery).
When performing a vasectomy procedure with thermal cautery combined with fascial interposition over the abdominal end, is it preferable to use dissolving sutures or a clip?
By preferable I mean reducing the likelihood of complications (such as post-vasectomy pain syndrome) and reducing the likelihood of recanalization of the vas deferens.
Illustration showing the use of dissolving sutures, from www.researchgate.net/publication/7824462_Vasectomy_surgical_techniques_in_South_and_South_East_Asia/figures?lo=1, license: CC BY 2.0:
Illustration showing the use of dissolving sutures, from simplevas.net/simplevas-vasectomy/:
Illustration showing the use of clips, from buenafeclinic.com/vasectomy/no-scalpel-no-needle/:
Illustration showing the use of clips, from simplevas.net/simplevas-vasectomy/:
thevasectomist.com.au/no-scalpel-vasectomy/ uses a 3mm titanium clip by default:
The tube has a thin slippery outer layer called fascia. The fascia is gently pulled over the stump and kept in place with a titanium clip or absorbable suture (we use a clip by default but are happy to use a suture if preferred). FI only needs to be performed up on one end. FI to the upper end is the preferred method, allowing the bottom end to be left alone (an open vasectomy).
How is the upper end blocked. A titanium clip works nicely to seal the fascia of the upper end. Suture is used on request. The 3mm clip is MRI friendly & doesn’t bleep in airports!
Same for buenafeclinic.com/vasectomy/no-scalpel-no-needle/:
This step involves tying the sheath or covering of the vas over one end of the cut tube with a small titanium clip or a dissolving thread (same result), to create a natural barrier between the two cut ends.open ended vasectomy hosptial in manitoba
Fascial interposition can be carried out using titanium metal clips which are left permanently in the scrotum, or with dissolvable thread. There are many different techniques used to block the vas, even among no scalpel vasectomy physicians
and same for simplevas.net/simplevas-vasectomy/, whereas www.pollockclinics.com/no-scalpel-vasectomy/our-approach/ recommends to use dissolving sutures:
Our doctors also carry out what many studies describe as a crucial step, called fascial interposition. This step involves securing a sheath of healthy tissue between the divided ends to create a physical barrier between the two cut ends.
We accomplish this using a dissolving suture so that no foreign bodies such as metal clips are left in your scrotum.
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One reference www.aafp.org/afp/2000/0115/p305.html recommends the use of sutures, and specifically the use of Vicryl or Dexon sutures as they cause less tissue reaction than the chromic suture:
I did use clips for fascial interposition during no-scalpel vasectomy for a period of time. I found that they frequently hung up in the narrow tissue tract when I let the vas slide back into its normal anatomic position. This created the dilemma of whether to leave the vas in the wrong plane and possibly cause chronic pain or vasocutaneous fistula, or to pull the vas down by testicular traction and potentially dislodge the clip. Hating this choice, I abandoned clips in favor of suture for the fascial interposition. Because they are hydrolyzed rather than phagocytosed, I find that Vicryl or Dexon suture causes less tissue reaction than the chromic suture recommended by Drs. Clenney and Higgins.
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