Performing an Open Ended Vasectomy
An open-ended vasectomy is when the lower end of the divided vas deferens is allowed to remain open at the end of the vasectomy. This allows for gradual drainage of sperm and minimizes the sudden increases in pressure felt downstream by the epididymis immediately after a vasectomy procedure. As healing occurs, the sperm will be consumed/recycled at the entrance to the lower open end and the epididymis will benefit from this lower overall back pressure.
After coagulating and dividing the vas deferens, the upper end is then re-inserted back into its fascial covering.
The lower end is then elevated slightly and positioned so the opened lower end is clearly above the fascial layer. The lower end is now in a distinct anatomical space and completely separated from the upper end. This is an additional step that decreases vasectomy failure rate.
A small titanium clip is then applied over the fascial opening so it is much more difficult for the two divided ends of the vas deferens to reconnect or create an abnormal connection through healing granulation tissue. The upper prostatic end is inside the fascial layer and the lower testicular end is above the fascial layer.
A small titanium clip is much easier and quicker to apply. Suture on a needle can be used for this step but this increases the risk of bleeding and increases the time it takes to complete the procedure. A free tie suture can also be used but this also increases the procedure time. Dissolvable sutures increase inflammation and contribute to suture granuloma formation.
The titanium clip is quick, efficient, and minimizes the risk of bleeding. The clip is also small and non-reactive so less inflammation occurs with titanium clip usage.
What makes this an open ended procedure?
The lower testicular end is intentionally allowed to remain open and this is what makes this an open-ended procedure. The intention is to leave the testicular end open so small amounts of sperm can leak from this end and relieve downstream pressure on the epididymis.
During healing the leaked sperm will be contained at the very end of this opening of the lower testicular portion of the vas deferens. This area will actually form a small granuloma. This granuloma will allow white blood cells to degrade and recycle sperm and this will prevent the epididymis from experiencing increased in pressure after the vasectomy.
Although debatable, this may decrease the amount of discomfort experienced after a vasectomy, minimize inflammation in the epididymis, and possibly increase the chance of successful reversal if required.