According to https://vasectomie.net/Vasectomy_AUA_guideline.pdf:

The panel does not advocate the omission of FI (fascial interposition) in performing open ended vasectomy with MC (mucosal cautery).

When performing a vasectomy procedure with thermal cautery combined with fascial interposition over the abdominal end, is it preferable to use dissolving sutures or a clip?

By preferable I mean reducing the likelihood of complications (such as post-vasectomy pain syndrome) and reducing the likelihood of recanalization of the vas deferens.

Illustration showing the use of dissolving sutures, from https://www.researchgate.net/publication/7824462_Vasectomy_surgical_techniques_in_South_and_South_East_Asia/figures?lo=1, license: CC BY 2.0:

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Illustration showing the use of dissolving sutures, from https://simplevas.net/simplevas-vasectomy/:

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Illustration showing the use of clips, from https://buenafeclinic.com/vasectomy/no-scalpel-no-needle/:

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Illustration showing the use of clips, from https://simplevas.net/simplevas-vasectomy/: enter image description here

https://thevasectomist.com.au/no-scalpel-vasectomy/ uses a 3mm titanium clip by default:

The tube has a thin slippery outer layer called fascia. The fascia is gently pulled over the stump and kept in place with a titanium clip or absorbable suture (we use a clip by default but are happy to use a suture if preferred). FI only needs to be performed up on one end. FI to the upper end is the preferred method, allowing the bottom end to be left alone (an open vasectomy).

How is the upper end blocked. A titanium clip works nicely to seal the fascia of the upper end. Suture is used on request. The 3mm clip is MRI friendly & doesn’t bleep in airports!

Same for https://buenafeclinic.com/vasectomy/no-scalpel-no-needle/:

This step involves tying the sheath or covering of the vas over one end of the cut tube with a small titanium clip or a dissolving thread (same result), to create a natural barrier between the two cut ends.open ended vasectomy hosptial in manitoba

Fascial interposition can be carried out using titanium metal clips which are left permanently in the scrotum, or with dissolvable thread. There are many different techniques used to block the vas, even among no scalpel vasectomy physicians

and same for https://simplevas.net/simplevas-vasectomy/, whereas https://www.pollockclinics.com/no-scalpel-vasectomy/our-approach/ recommends to use dissolving sutures:

Our doctors also carry out what many studies describe as a crucial step, called fascial interposition. This step involves securing a sheath of healthy tissue between the divided ends to create a physical barrier between the two cut ends.

We accomplish this using a dissolving suture so that no foreign bodies such as metal clips are left in your scrotum.

  • 1
    What has your research revealed so far? Surgeons must be making that choice so what are they basing their decisions on? Sep 13, 2020 at 5:40
  • @CareyGregory I haven't found any scientific reference so far, despite reading a fair amount of literature on vasectomies. Some surgeons use clips, some use dissolving sutures, and many don't follow the scientific literature very actively.
    – user19840
    Sep 13, 2020 at 7:49
  • These vasectomy questions are specific to the point of being impossible to answer; no scientific literature exists that will satisfactorily address this distinction between minor surgical device choices for an elective procedure. Sep 14, 2020 at 17:36
  • @BruceKirkpatrick "minor surgical device choices" -> That's exactly the question. How significant is this choice? You seem to assume this is a minor choice. You are most welcome to write an answer to explain why. The scientific literature on vasectomies is very dense, since over 50 million individuals have underwent a vasectomy so far. The fact that it is an elective procedure doesn't matter.
    – user19840
    Sep 14, 2020 at 20:56
  • @BruceKirkpatrick I've added an answer citing a reference. Feel free to contact the authors of the reference to asking them whether they think it is a "minor surgical device choice". You're also welcome to read more about post-vasectomy pain syndrome.
    – user19840
    Sep 14, 2020 at 21:12

1 Answer 1


One reference https://www.aafp.org/afp/2000/0115/p305.html recommends the use of sutures, and specifically the use of Vicryl or Dexon sutures as they cause less tissue reaction than the chromic suture:

I did use clips for fascial interposition during no-scalpel vasectomy for a period of time. I found that they frequently hung up in the narrow tissue tract when I let the vas slide back into its normal anatomic position. This created the dilemma of whether to leave the vas in the wrong plane and possibly cause chronic pain or vasocutaneous fistula, or to pull the vas down by testicular traction and potentially dislodge the clip. Hating this choice, I abandoned clips in favor of suture for the fascial interposition. Because they are hydrolyzed rather than phagocytosed, I find that Vicryl or Dexon suture causes less tissue reaction than the chromic suture recommended by Drs. Clenney and Higgins.

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