End-to-side Group Research Articles

End-to-side versus end-to-end uretero-ureteral anastomosis in preemptive kidney transplantation from living donors: A monocentric experience.

End-to-end (ETE) pyeloureterostomy is an alternative to ureteroneocystostomy for urinary anastomosis during kidney transplantation (KT). In preemptive KT from living donors (PKT-LD), end-to-side (ETS) uretero-ureteral anastomosis could have the benefits of pyeloureterostomy without ligation of the native kidney ureter. This study aimed to compare ETS to ETE uretero-ureteral anastomosis in PKT-LD. A monocentric retrospective 8-year study included all consecutive cases of PKT-LD, excluding ureteroneocystomy anastomosis and homolateral nephrectomy. Two groups were compared: ETS and ETE. Perioperative data on graft function and urological complications were collected. One hundred and six patients were included: 48 patients in the ETS group and 58 patients in the ETE group. Median follow-up was 37.5 months [17.3; 57.5]. The estimated glomerular filtration rate at postoperative day ten and 3 months was similar in both groups. The overall complication rate was 16%, with no significant difference between the 2 groups. There was one ureteral stenosis in each group. None of the patients in the ETS group presented urinary fistula, whereas it occurred in one (1.7%) in the ETE group. Back pain due to native kidney obstruction occurred in 5 patients in the ETE group (8.6%), but not in the ETS group. In preemptive kidney transplantation from living donors, urinary anastomosis can safely be performed as an end-to-side uretero-ureteral anastomosis, with low urological complications. It could prevent symptoms and complications due to native kidney obstruction. IV.

End-to-side Anastomosis on Digital Arteries: Just a Technical Choice or a Real Benefit?

Background:High-quality evidence is currently poor regarding the benefits of end-to-end (ETE) or end-to-side (ETS) anastomosis in arterial and venous anastomoses, despite being postulated as a potential influence on outcomes. A sufficient microvascular anastomosis is indispensable for the success of any free tissue transfer. ETS microvascular anastomoses have been becoming increasingly important as they allow reconstruction even in patients with impaired vascular status. To the authors’ knowledge, no studies have examined the choice of ETE or ETS anastomoses specifically for digital arteries.Methods:We conducted a retrospective study of ETE and ETS anastomosis cases; the only inclusion criteria was that digital arteries (proper, common) were the recipient vessels.Results:Fifty-seven cases met the inclusion criteria. All the venous anastomoses were ETE. Of these cases, four total intraoperative complications (immediate thrombosis) and only one case of complete failure were registered. The ETE group consisted of 49 patients and the ETS group of eight patients. A comparison of the mean ischemia time in the two groups showed no statistically significant difference (P = 0.121).Conclusions:We observed no difference in the reconstructive outcomes of hand free-flaps and reconstruction between ETE or ETS digital arteries anastomoses. The successful microsurgical reconstruction was independent of anastomotic technique. In particular, the results of our study demonstrated no statistically significant increase of the ischemia time; thus, no prolongation of operative time can be attributed to the higher technical challenge of the anastomosis.

A comparison of extracorporeal side to side or end to side anastomosis following a laparoscopic right hemicolectomy for colon cancer.

BackgroundThis study aimed to investigate whether an extracorporeal side‐to‐side (SS) or end‐to‐side (ES) stapled anastomosis impacts short‐term and long‐term outcomes after an oncological laparoscopic right hemicolectomy.MethodsA retrospective cohort study of prospectively collected data from two Victorian tertiary referral hospitals was performed. Patients who underwent oncological resection for colorectal cancer between February 2010 and September 2020 were selected from the colorectal neoplasia database. Patients were divided into two groups depending on the type of stapled anastomosis: Group 1 (functional end‐to‐end/side‐to‐side (SS)); and Group 2 (end‐to‐side (ES)). Primary outcomes were anastomotic leak, postoperative ileus, mortality and morbidity, length of stay post‐surgery, readmission to hospital, and 30‐day mortality.ResultsThis large case series of 1040 patients (SS = 625, ES = 415) demonstrated that the type of stapling technique impacted operative duration and postoperative ileus rates. Patients in the SS group had a faster operation of 108 min rather than 130 min in the ES group (p < 0.001). The SS group were more likely to experience a post‐operative ileus (p < 0.001) with no impact on length of stay (SS, 7 days versus ES, 7 days; p = 0.14). There were no differences between the two groups with respect to lymph node yield, lymph node ratio, anastomotic leaks, return to theatre, 30‐day mortality and 5‐year overall survival.DiscussionThe type of extracorporeal stapled anastomosis following an oncological laparoscopic right hemicolectomy has minimal impact on morbidity and survival outcomes; however, a side‐to‐side stapled anastomosis is more likely to be a faster operation with a higher postoperative ileus rate.

Comparison between the Techniques of Radiocephalic Arteriovenous Fistulas for Haemodialysis: A Retrospective Analytical Study

Introduction: Chronic Kidney Disease (CKD) has become a major health issue worldwide. CKD patients require Renal Replacement Therapy (RRT) throughout their life. Haemodialysis is one of the options for RRT. Arterio-Venous Fistula (AVF) creation is required for haemodialysis. The radiocephalic fistula is the initial option for creating vascular access. Fistula can be created by anastomosing cephalic vein to radial artery either by End-To-Side (ETS) or Side-To-Side (STS) techniques. Aim: To compare the efficacy rate of radiocephalic AVF using ETS or STS anastomotic methods. Materials and Methods: This was a retrospective analytical study conducted at SDM college of medical sciences and hospital, Dharwad from March 2017 to February 2020. A total of 43 CKD patients were enlisted for the above duration from the hospital records. These patients were included in the study since they underwent radiocephalic AVF creation. AVF creation at other anatomical sites for rest of the CKD patients was excluded. Out of 43 patients, 24 of them underwent ETS technique and 19 STS technique; 15 patients from the former group and 17 from the latter were followed-up for a period of three months. Eleven patients were lost to follow-up. Demographic variables were analysed with frequency, mean and standard deviation. Its association with two different operative techniques was analysed using Fisher’s-exact test. Outcome of the two operative procedures was analysed using Student’s t-test. Results: Effectively 15 patients from ETS group and 17 from STS group were compared. Three (20%) in ETS group and 5 (29.41%) in STS group had primary failure. Mean of maturation time in weeks in ETS group was 4.73±2.73 weeks and in STS group was 5.29±3.75 weeks. Three months patency rate in ETS group was 12 (80%) and in STS group was 12 (70.58%). Student’s t-test was performed comparing the above parameters and no statistical significance was noted. Conclusion: Comparison of two techniques of radiocephalic AVF creation proves that both the techniques are beneficial with no superiority of one over other.

Modified Collard versus end-to-side hand-sewn anastomosis for cervical anastomosis after McKeown esophagectomy.

BackgroundAccording to previously published studies, esophagectomy with modified Collard anastomosis has been reported to have low incidences of anastomotic leak and stricture. However, the optional anastomotic method after esophagectomy is still controversial. We conducted this study to compare the incidence of postoperative anastomotic stricture formation and dysphagia over three years after an esophagectomy with modified Collard anastomosis (MC) or end‐to‐side (ETS) hand‐sewn anastomosis. Meanwhile, the early postoperative anastomotic leakage and other complications, hospital stay and 30‐ and 90‐day mortality were also evaluated.MethodsThe clinical data of 905 patients undergoing McKeown esophagectomy were retrospectively reviewed. The rate of postoperative stricture formation after three years was demonstrated by stricture‐free survival which is the primary end‐point of this study. The incidence of dysphagia, first time of onset of stricture and number of dilatations were also recorded during follow‐up.ResultsThe incidence of anastomotic leak tended to be higher in the MC group compared with that in the ETS group (13.0% vs. 8.7%, P = 0.064). The rates of anastomotic stricture in the MC group were significantly less than in the ETS group (P = 0.004). The number of dilatations in the MC group were significantly greater than those in the ETS group (2.34 vs. 2.46, P = 0.011).ConclusionsA modified Collard cervical esophagogastric anastomosis was associated with lower rates of anastomotic stricture and dysphagia, compared with ETS hand‐sewn anastomosis. However, the modified Collard anastomosis is accompanied by an increased anastomotic leakage rate.

Comparison of Outcomes of End-to-End versus End-to-Side Anastomoses in Lower Extremity Free Flap Reconstructions.

Whether to perform an end-to-end (ETE) versus end-to-side (ETS) arterial anastomosis is an integral part of preoperative planning and intraoperative decision making in free flap-based reconstructions. This study evaluated the impact of microsurgical anastomotic technique on outcomes of lower extremity reconstructions, with a focus on patients with peripheral arterial disease (PAD). Over a 6-year period, 425 patients underwent 437 microvascular lower extremity free flap reconstructions with fasciocutaneous anterolateral thigh- or gracilis muscle flaps at a single surgical center. The cases were divided into an ETE (n = 297 patients) versus ETS (n = 128 patients) group according to the anastomotic technique. A retrospective analysis of patients' demographics, perioperative details, surgical complications, free flap types, recipient sites, flap survival, and the potential impact of PAD on outcomes was performed. Patient groups were comparable regarding comorbidities, American Society of Anesthesiologists scores, types of performed free flaps and recipient sites. We found no significant differences between the ETE versus ETS groups regarding the rate of major or minor complications (p > 0.05). Specifically, in patients suffering from PAD (n = 64) the type of arterial anastomosis had no effect on the outcome. Overall, no significant differences in outcomes were observed when comparing the types of performed arterial anastomosis. This observation also held true for the subgroup of patients with PAD. Given that an ETS anastomosis did not increase the risk to encounter complications while preserving distal perfusion, we believe that this technique is the method of choice, especially in patients with impaired vascular status.

End-to-End Versus End-to-Side Hand-Sewn Anastomosis for Minimally Invasive McKeown Esophagectomy.

Standard anastomotic configuration for esophagogastric anastomosis is not conclusive. This study aimed to compare the short-term outcomes of end-to-end (ETE) cervical double-layer hand-sewn anastomoses with those of end-to-side (ETS) anastomoses for minimally invasive McKeown esophagectomy. Between January 2016 and December 2017, the clinical data of 252 consecutive patients who underwent minimally invasive esophagectomy were reviewed retrospectively. The 252 patients comprised 130 patients in the ETS group and 122 patients in the ETE group. The same surgical procedures were applied in both groups, except for esophagogastric reconstruction. Short-term outcomes including leakage, stricture, reflux, operative features, and other surgical complications were analyzed for a comparison of the two configurations. The ETS and ETE groups did not differ significantly in terms of leakage rate (P = 0.34), anastomotic stricture rate (P = 0.70), or postoperative reflux (P = 0.66). However, the ETS group had a longer operation time (P = 0.011), a longer anastomosis time (P < 0.001), and a longer postoperative hospital stay (P = 0.009) than the ETE group, and the postoperative gastric dilation rates were lower in ETE group than in the ETS group (P = 0.025). The two groups did not differ significantly in terms of other postoperative complications. The major postoperative complications were comparable for the two anastomotic configurations. However, the patients with ETE anastomosis showed a favorable outcome in terms of a decreasing postoperative thoracic gastric dilation rate. End-to-end anastomosis also seemed to have slight advantages in terms of shorter operation and anastomosis times as well as a shorter postoperative hospital stay.

Effect of FK1706 on nerve regeneration after end-to-side neurorrhaphy of autonomic nerve and somatic nerve in rats

Objective To evaluate the effect of FK1706 on nerve regeneration after end-to-side (ETS) neurorrhaphy of autonomic nerve and somatic nerve in rats through morphological observation. Methods Thirty rats were randomly divided into three groups in terms of different treatments (n=10 in each group). In FK1706 group, the left L6 ventral root (L6VR) and L4 ventral root (L4VR) of rats were sutured in an ETS fashion and FK1706 (0.3 mg/kg) was administrated subcutaneously for 5 consecutive days per week for a total of 8 weeks after ETS neurorrhaphy. In ETS group, the same operation as FK1706 group was performed but without FK1706 applied after surgery. In control group, left L6 dorsal root (L6DR), S1 ventral root (S1VR) and S1 dorsal root (S1DR) were transected but the left L6VR was preserved as normal control. After 4 months, the left pelvic parasympathetic nerve (PPN) to which L6VR extended was harvested for semithin and ultrathin sections in FK1706 and ETS groups to count the number of myelinated axons. The number and morphology of myelinated axons and thickness of myelin sheath were compared between the two groups. Results After 4 months, the morphology of the regenerated L6VR distal to the neurorrhaphy site in FK1706 and ETS groups was normal. The number of regenerated myelinated axons of PPN was 515.6±43.3 and 328.4±46.4 in FK1706 and ETS groups, respectively (P=0.000). The thickness of myelin sheath of regenerated PPN was (0.672 4±0.110 1) μm and (0.466 8±0.076 3) μm in FK1706 and ETS groups, respectively (P=0.000). Conclusion The effect of autonomic nerve regeneration could be enhanced after ETS neurorrhaphy of autonomic nerve and somatic nerve through FK1706, which could improve rehabilitation of nerve injury. Key words: FK1706; Nerve regeneration; Autonomic nerve; Somatic nerve; End-to-side neurorrhaphy

End-To-Side versus Side-To-Side Anastomosis in Upper Limb Arteriovenous Fistula for Dialysis Access: A Systematic Review and a Meta-Analysis

An arteriovenous fistula (AVF) is the best modality for hemodialysis access. The end-to-side (ETS) technique has been suggested in the literature to produce superior results to the side-to-side (STS) approach; however, in the absence of a systematic review, this practice remains debatable. Online search for randomized controlled trials and observational studies that compared the ETS versus the STS anastomosis techniques in creating an upper limb AVF. Aims were to systematically assess the difference between both procedures in terms of access maturation, patency, and postoperative complications. Seven studies were included with 463 patients in the ETS group and 523 in the STS group. The difference between the 2 techniques was not significant in relation to patency rates at 3, 6, 12, and 24months (P values: 0.28, 0.82, 0.54, and 0.21, respectively). There were fewer cases of postoperative hematoma in the ETS group; however, the difference was not significant (P=0.09). Arterial steal syndrome was found to be significantly associated with the STS configuration in pooled analysis (pooled risk ratio=0.11 [0.01-0.88], 95% CI, P=0.04). Similar maturation rates between ETS and STS fistula configuration, however, arterial steal syndrome was significantly associated with the STS technique. ETS will likely remain as the preferred AVF configuration as it is less technically demanding.

Antecubital arteriovenous fistula in hemodialysis; a comparison between side-to-side versus end-to-side venous anastomosis

Introduction: Chronic Kidney Disease (CKD) is a global health problem which is growing in prevalence. Hemodialysis is the most common treatment for end-stage renal disease (ESRD) which requires a permanent vascular access. Vascular accesses should have a good patency and low complication. Objectives: The present study aimed to compare side-to-side (STS) versus end-to-side (ETS) methods in antecubital arteriovenous fistulas in dialysis patients. Patients and Methods: In this randomized, single-blind clinical trial, 100 ESRD patients who scheduled for hemodialysis were divided into two groups. STS arteriovenous anastomosis was employed in one group and in the other, the ETS approach was conducted. Follow ups were done after 1, 8, and 24 weeks to detect fistula maturation and immediate or delayed complications. Results: The STS anastomosis group demonstrated higher rates of delayed maturation, vascular aneurism, and venous hypertension syndrome than ETS anastomosis group. The ETS group, however, showed higher rates of venous thrombosis and vascular stenosis. Overall, the rate of complications was 24% and 8% for STS and ETS anastomosis group respectively (P =0.03). Conclusion: In comparison, ETS arteriovenous fistulas involve less complications than STS method in ESRD patients. However, more thrombosis and stenosis detected by ETS method. ETS arteriovenous fistulas had less delayed maturation, aneurism, venous hypertension and overall complications than STS approach. ETS arteriovenous fistulas contributes to establishing a more stable connection to hemodialysis machine to conduct a more effective hemodialysis.

End-to-end versus end-to-side anastomoses in free flap reconstruction: single centre experiences

Background: The choice of microsurgical anastomotic technique, end-to-end (ETE) or end-to-side (ETS), is a relevant point in free tissue transfer. The decision-making process of choosing ETE or ETS technique depends on several clinical and perioperative factors. This study evaluates the outcomes of microvascular procedures in a large single centre patient series, focusing on ETE vs ETS arterial anastomoses.Materials and methods: Between January 2009 and June 2015, 838 patients underwent free flap surgery for reconstruction after trauma, infection, or malignancies. The cases were divided according to the microsurgical technique of the arterial anastomosis into an ETE (n = 693) and an ETS (n = 145) group. The series was retrospectively analysed and the two groups compared regarding outcomes.Results: Overall, there was no significant difference in rates of surgical complications, flap failures, and re-explorations between the patient groups during the 3-months follow-up period.Conclusion: The presented analysis includes a large series of microsurgical reconstructions evaluating outcomes in respect to type of performed arterial anastomosis. While the decision of performing an ETE or ETS arterial anastomosis must be made according to recipient vessel quality and accessibility, given no change in outcomes, an ETS anastomosis should be performed whenever feasible in order to preserve distal perfusion.

Reply to Letter

Nederlof, Nina BSc; Tilanus, Hugo W. MD, PhD; Tran, T. C. Khe MD; Hop, Wim C. J. PhD; Wijnhoven, Bas P. L. MD, PhD; de Jonge, Jeroen MD, PhD Author Information

Comparison of Efficacy of Side to Side Versus End to Side Arteriovenous Fistulae Formation in Chronic Renal Failure as a Permanent Hemodialysis Access

BackgroundIn candidate patients for permanent hemodialysis or dialysis on a regular basis, an appropriate vascular access has great importance. The best permanent access is AVF (arterio venous fistula). Use of a technique to create AVF with better patency seems to be logical.ObjectivesThe present study aimed to compare the efficacy rate of AVFs using two different anastomosis methods; Side to Side (STS) versus End to Side (ETS) and to determine whether the different approaches render any preferences or complications.Patients and MethodsSixty end stage renal disease (ESRD) patients were included in this clinical trial in two assigned groups of 30 patients. In one group end to side method to create AVF was used while in the other group Side to Side technique was applied for access in surgery. Both groups were followed for duration of 6 months to assess patency. For evaluating the quantitive variables, t-test was used while qualitative variables were measured using the chi-square and Fisher`s exact tests.ResultsIn the 6 months duration, 6 patients (20%) in the STS (side to side) group and 5 patients (16.6%) in the ETS (end to side) group experienced a non-functional AVF. In the ETS group the failure was generally a result of thrombosed access while in the STS group, 4 out of 6 patients with complications, experienced thrombosis while the other 2 patients had venous hypertension. The total failure rate was 18.3% and during the 6 months of follow up no significant difference was detected in the efficacy rate. Nevertheless, in case of longer follow ups, different outcomes could be seen.ConclusionsThis study demonstrated that there was no significant statistical difference between the functional patency rates of fistulae placed by STS or ETS methods.

The Suitability of End-to-Side Microvascular Anastomosis in Free Flap Transfer for Limb Reconstruction

End-to-end (ETE) microvascular anastomosis used in free flap transfer for limb reconstruction often requires the sacrifice of a major artery, which may aggravate distal circulation of the limb. The purpose of this study is to investigate the relationship between the type of microvascular anastomosis and the survival of free flaps, and to highlight the end-to-side (ETS) anastomotic technique when facing vascular anatomic variations. Between 1999 and 2008, a retrospective review was conducted by a single microsurgeon on 203 patients who underwent free flap reconstruction for limb reconstruction. We examined the clinical course of 209 arterial and 308 venous anastomoses. ETS anastomoses were performed for 99 vessels, whereas ETE anastomoses for 418 vessels. The distribution and outcome of ETS and ETE anastomoses were compared. One arterial thrombosis (1.15%, 1/87) was recorded in ETS anastomosis group, whereas none (0%, 0/122) was recorded in ETE anastomosis group (P = 0.419). Four venous thromboses (1.35%, 4/296) were found in ETE group, whereas none was found in ETS group (0%, 0/12). There was no statistically significant difference between the 2 anastomotic techniques. Six cases with double pedicles needed ETS anastomosis for 2 arterial and 2 venous reconstructions. Flap survival rate in ETS arterial group was 98.8%, whereas in ETE arterial group, it was 100%. ETS microvascular anastomosis has an equivalent flap survival rate as compared with ETE microvascular anastomosis. ETS anastomosis should be considered first when facing vessel size discrepancy and for preserving the major arteries of limbs.

Effect of Anastomotic Method on Intimal Hyperplasia in Rabbit Aorta

Purpose: The clinical advantages of end-to-end (ETE) anastomosis have not been clear despite its biomechanical advantage over end-to-side (ETS) anastomosis. We compared the histomorphometric features of intimal remodeling after ETE and ETS anastomosis in a rabbit aortic bypass model. Methods: Thirty-two bypass operations, 16 with ETS and 16 with ETE anastomoses, were performed using aortic allografts of donor rabbits (15 per group) and polytetrafluoroethylene (PTFE) grafts (1 per group). To minimize bias from the immunologic response to aortic allografts or graft size, a long aortic tissue obtained from one donor was divided into 2 pieces and shared between each ETE and ETS bypass. PTFE graft bypasses, which are commonly used in clinical practice, were performed to provide comparison results for an allograft with a different compliance. Vessels were harvested at 1 day (1 per group), 5 days (1 per group), and 4 weeks (14 per group, including the PTFE bypass group) after surgery. Intimal thickening was evaluated with hematoxylin-eosin, van Gieson, immunohistochemical staining and Western blot analysis of TNF-α and proliferative cell nuclear antigen (PCNA) expression. Results: Mean intimal thickness and volume (0.721±0.047 ㎜, 5.734±0.387 ㎣ vs. 0.883±0.048 mm, 9.068±0.462 ㎣) and intima/media volume ratio (0.70±0.05 vs 1.08±0.06) were significantly smaller in ETE (P＜0.05). Western blotting showed a marked increase in TNF-α (203.15±5.29 vs. 494.49±6.11) and PCNA concentrations (152.66±7.37 vs. 175.53±4.36) in the ETS group. Conclusion: ETE anastomosis results showed significantly decreased inflammatory reaction and volume of intimal hyperplasia, and therefore seemed to be associated with better long-term graft patency.

OUTCOME AND LATE FAILURES COMPARED IN 4 TECHNIQUES OF MICROSURGICAL VASOEPIDIDYMOSTOMY IN 153 CONSECUTIVE MEN

Vasoepididymostomy remains one of the most technically challenging procedures in all of microsurgery. The technique has evolved from an end-to-end, to an end-to-side technique, then to intussusception end-to-side methods. We recently reported the superiority of 2-suture longitudinal and 3-suture triangulation intussusception techniques in rats. In the present study we report our results in humans. We evaluated all vasoepididymostomies performed by 1 surgeon from January 1992 until the present for patency, pregnancy and for disappearance of sperm after initial return of sperm to the ejaculate. We recorded the results of 153 consecutive vasoepdidymostomies done by 1 surgeon (MG) from January 1992 until February 2004. Four techniques were used, namely end-to-end (EE), end-to-side (ES), 3-suture triangulation intussusception (TIVE) and 2-suture longitudinal intussusception (LIVE). Data collected included technique, months of followup, sperm density, motility and morphology (WHO 1992 criteria), pregnancy outcome and late failures. Late failures were defined as having return of sperm to the ejaculate after vasoepididymostomy and then becoming azoospermic on at least 2 subsequent semen analyses. A total of 153 men underwent bilateral vasoepididymostomies. The most recent 17 were LIVE, preceeded by 38 TIVE, 32 ES and 66 EE. Mean followup for the groups were 17.2 (LIVE), 70.8 (TIVE), 116.7 (ES) and 140.2 (EE) months, respectively. Intact sperm were seen in the ejaculates of 12 men (80%) in the LIVE group, 16 in the TIVE group (84%), 20 in the ES group (74%) and 30 men in the EE group (73%). Motile sperm were found in the ejaculates of 10 of 15 (67%) in the LIVE group, 13 of 19 (68%) in the TIVE group, 10 of 27 (37%) in the ES group and 20 of 41 (49%) in the EE group (p =0.2). Mean times for return of sperm to the ejaculate were 2.9, 2.8, 2.8 and 3.5 months, respectively. Pregnancies were reported by 4 men in the LIVE group all before 12 months, 6 in the TIVE group and 3 were by 12 months, and 4 each by the ES and EE groups with 3 and 2 by 12 months (p =0.07). Thus far, there have been no late failures in the LIVE group, only 1 in the TIVE group (8%), 5 in the ES group (50%) and 6 in the EE group (30%) (p =0.04). Although vasoepididymostomy remains a technically demanding microsurgical procedure, recent technical innovations of TIVE and LIVE offer better or comparable outcomes compared with EE and ES procedures with the use of fewer sutures, which simplifies the performance of the anastomosis. In addition, the late failure rate is lower with the use of the intussusception techniques (LIVE and TIVE) with only 1 late failure in 22 men with return of sperm to the ejaculate procedures (4%) compared with 11 of 30 (37%) in the nonintussusception groups (p =0.006).

Comparison of patency rates, pregnancy and late failures in four techniques of vasoepididymostomy in 143 consecutive patients

Comparison of patency rates, pregnancy and late failures in four techniques of vasoepididymostomy in 143 consecutive patients