Abstract
Abstract Introduction The most common adverse events following routine vasectomy procedures consist of infection and scrotal hematoma. Scrotal hematomas pose a challenge for patients due to their related pain and potential for extraneous procedures such as operative drainage. With a current documented prevalence of hematoma following vasectomy as ranging from 0–29% depending on institution and technique, we sought to decrease this relatively common complication. With the addition of one simple step following the incision of the vas deferens, our institution has successfully mitigated risk of scrotal hematoma. Objective To evaluate the effectiveness of a novel surgical technique in reducing the prevalence of scrotal hematomas following vasectomy. Methods Upon ideation and deployment of our technique in February 2021, we then documented procedural notes as well as any observed adverse events as part of the standard of care. The referenced technique involves securing the peri-vasal fascia with chromic suture during fascial interposition. As opposed to the traditional approach of cutting both suture-ends, we leave one intact, acting as a tether, to enable repeated reinsertion and inspection of the vas deferens’ hemostatic measures, as needed. Following over three years of implementation, we retroactively queried our electronic medical records to assess the efficacy of this new technique in curtailing subsequent scrotal hematomas compared to national rates. Relative risks and Clopper-Pearson Binomial Confidence Intervals (CI) were calculated for both institutional and national data utilizing SPSS software. Results Upon incorporation of this novel technique, commencing in February 2021, there has been one instance of significant hematoma following the secured vasectomy procedure based on ICD-10 codes associated with the encounter and subsequent follow-up visits. With 579 documented procedures performed utilizing this technique at our institution, we observed a 0.17% prevalence rate (95% CI [0.00004, 0.0096]). Compared to national data of 2%, this resulted in a significant relative risk reduction of scrotal hematoma (p = .0023) (Table One). Conclusions Though a generally innocuous, yet irritating, complication for patients, scrotal hematomas following vasectomy have become regarded as a relatively common ramification of standard procedure. However, there is reason to contest this complacency and attempt to decrease the frequency of this adverse event. With the implementation of this simplistic step intraoperatively, we can assess bleeding from the vasal artery in both the current and assess risk for delayed bleeding. This technique allows for greater autonomy for the physician, allowing them to maintain prolonged control of the vas deferens until they are confident in the cessation of bleeding. These early favorable results warrant further investigation into this circumspect approach. Disclosure No.
Published Version
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