Can a Hernia Repair with Mesh Impact on Vasectomy Reversal Success Rates?
No, most often a hernia repair with mesh will not impact on vasectomy reversal success.
This blog was written by vas reversal authority, author and microsurgeon Dr. Sheldon Marks of ICVR, updated in 2023, to address some of the issues and concerns with prior hernia repairs and concerns over the possible impact on vasectomy reversal success rates.
Can a Hernia Repair Damage the Vas?
Many of the thousands of men we see for a vasectomy reversal have had a prior hernia repair in the groin, on one or both sides. Most often they have had one repair, but some men have more than one hernia repair, also called a herniorrhaphy. Because the vas deferens, which carries the sperm from the testicle, passes up though the area of the hernia in the groin, there are concerns that on on rare occasions the vas might be damaged or inadvertently cut or tied off, blocking the flow of sperm on that side. Just as bad is the mesh that surgeons insert into the tissue gap or weakness to prevent future inguinal hernias, as the mesh is designed to strengthen the repair by causing a dense inflammatory reaction with scarring which can, on rare occasions, surround and involve the vas, and so cause lengthy obstruction within the vas.
If the general surgeon knows that the patient already had a vasectomy, then they sometimes will actually cut the vas when performing the hernia repair, thinking that it was already blocked and damaging the vas one more time won’t make a difference. They might also be a little more aggressive when placing the mesh or sutures next to the vas, which can all lead to lengthy blockage of the vas high up in the groin or even deep in the pelvis.
How Often Does Hernia Surgery Damage the Vas?
The good news is that this inadvertent blockage is VERY rare, as we have seen this only a handful of times in more than 7000 vasectomy reversals over several decades. But when we do discover an unexpected blockage high up in the groin, then most often we are unable to perform the planned standard reverse vasectomy connection. At that point we would obtain sperm for banking from that blocked side, as desired by the couple, and go ahead with the standard microsurgical vasectomy reversal on the other, unblocked side.
Over many years, we have reviewed the patient’s surgical operative report about the hernia repair and found that it rarely provides any specific information when we are trying to assess if there is any damage to the vas that might have occurred during or after the hernia repair.
When we have encountered this unexpected blockage, we have tried in the past to explore the groin area where the hernia repair was performed. Only on very rare occasions can we find the two ends of the vas to be able to do a reverse vasectomy. More likely, if our patient wants that side reconstructed, and we know ahead of time that the vas was damaged, we would refer him to a urologic microsurgeon who is skilled with a deep pelvic vas reversal laparoscopically with a robot assist, though these may cost significantly more.
What if There is a Hernia Surgery Scheduled?
If anyone is planning on having an inguinal hernia repair and already had a vasectomy, we still recommend that it is smart to ask for the urologist to talk with the general surgeon before the hernia repair and let the general surgeon know that it is important to preserve the vas for possible future vas reversal and fertility restoration.
For any questions about vasectomy reversals at our full time, vas reversal only “Center of Excellence” or when ready, to set up a no-cost consult with either Dr. Sheldon Marks or Dr. Peter Burrows by phone, Zoom, Skype, Face Time or in person call
This blog was reviewed, edited and updated on June 13, 2023, by Sheldon H. F. Marks, MD.
