PREOPERATIVE DIAGNOSES:
- Voluntary sterilization.
- Previous failed bilateral vasectomy.
POSTOPERATIVE DIAGNOSES:
- Voluntary sterilization.
- Previous failed bilateral vasectomy.
PROCEDURES PERFORMED:
- Bilateral open vasectomy.
- Scrotal explorations.
SURGEON: John Doe, MD
ANESTHESIA: General anesthesia via LMA.
COMPLICATIONS: None.
DRAINS: None.
ESTIMATED BLOOD LOSS: Minimal.
DESCRIPTION OF PROCEDURE: The patient was placed on the operating table in the supine position. General anesthesia was administered via LMA. The genitalia was sterilely prepped and draped in the usual fashion.
A midline scrotal incision was made and carried down to the surface of the left vas deferens, which was grasped between fingers. The old vasectomy site was easily palpable. The old vasectomy site was dissected free and sent to pathology for examination.
A nylon suture material was clearly visible around the vas at the old vasectomy site. The two ends of the vas that were then exposed were fulgurated for hemostasis and then 0 silk free ties were placed on the proximal end and on the distal end. Hemostasis was obtained throughout the procedure, when needed, with electrocautery.
The tunica of the testicle was then opened and the testicle exposed. The epididymis was examined carefully for possible accessory vas deferens material. None was found. An appendix epididymis from the left epididymis was removed and sent to pathology.
The testicle was then returned to its tunica, which was then closed with a running 3-0 chromic suture. The testicle was returned in intrascrotal position.
The right-sided vasectomy site was then identified and resected. It was sent to pathology for examination.
Again, nylon suture material was clearly visible on the vas from the previous vasectomy site. The right-sided vas was tied proximally and distally with a 2-0 silk suture. Hemostasis was obtained, when needed, with electrocautery.
The testicle was exposed. A small appendix testis was removed and sent to pathology. The epididymis appeared unremarkable and there was no evidence of an accessory vas deferens.
The testicle was then returned to its tunica and the tunica was closed with a running 3-0 chromic. The testicle was then returned to an intrascrotal position.
A final check for hemostasis was made. The dartos layer was then closed with a running 3-0 chromic suture. The skin was closed with an interrupted vertical mattress 2-0 chromic suture.
Polysporin ointment and sterile dressings were applied. Sponge and needle counts were correct x2.
The patient tolerated the procedure well and left the recovery room in satisfactory condition.
