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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.

Next Series: Completing The Vasectomy and Closing The Skin Opening

What Our Patients Are Saying

"Dr. Monteith prepared me mentally for the pre, during and post procedure journey. He also provided me with all the tools necessary for a comfortable recovery. I'm definitely confident in this Dr's work, and especially glad at how little pain I experienced throughout the process. It would be worth it to visit Dr. Monteith no matter what state you have to travel from, I drove from Virginia."

- J.R.

"Very comforting and knowledgeable experience not only was the staff pleasant so was the atmosphere! I drove 3 hours so i did my research. I was impressed with the information, visuals, and on hand knowledge about what the procedure was all about. I felt like an expert after i left! Not to mention the 45 min in and out time. I will be recommending this to all my colleagues thank you!"

- J.W.

"Dr Monteith, and his staff, were all very professional about my decision to have a vastectomy. They informed me of the risks, the surgery procedure, and the post-surgery care. The procedure itself was relatively painless. I would rate this as a 2/10. I highly recommend Dr Monteith; he even sent me a text message after the surgery to give me a personal update on my procedure. The procedure was quick."

- S.E.

"If you're in the market for a Vasectomy you need to give Dr. Monteith a serious look. Just compare the information on his website to the information you'll get from other options around the triangle. It's hard to get solid answers on cost, procedure and expectations up front from other offices but His Choice plays no games and has great informative well designed website. Dr. Monteith makes it easy!"

- J.P.

"Excellent care. I visited Dr. Monteith for a single visit appointment on a Friday. Very clean, comfortable office. Pleasant staff. The procedure was quick and I went back to work for a little while. The only pain I experienced was soreness beginning about 4 hours post procedure, lasting for 24 hours, then subsiding rapidly. I was fine by Monday. The office checked on me twice, no problems. I would recommend Dr. Monteith to anyone.

- M.D.

Ask Us A Question!

Your questions about our services will be answered directly and promptly by our staff or Dr. Monteith. We will not respond to general medical questions or if you are a patient of another practice and are contacting us because you are not getting answers from your physician.

If you have been a patient at our center and have specific questions about your medical care you should contact the staff directly at (919) 977-5060.

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