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in certain conditions a more complex reconstruction is required known as an epididymal vez hasta me or vasoepididymostomy the animation provides a brief overview of the relevant anatomy with the vas deferens prior vasectomy site epididymis and testicle highlighted this procedure begins in a similar manner to a vasovasostomy a midline scrotal incision is made after which the obstructed Vasil segment is removed and the fluid on the testicular side is sampled under microscopy in this particular case microscopic analysis does not demonstrate the presence of any sperm in that scenario we would proceed with an epididymal vez ostomy the scrotal midline incision is extended after which the testicle is delivered through the wound this permits better visualization of the epididymis next the epididymis is incised and an obstructed epididymal tubule is selected for anastomosis the vas deferens is brought down to the level of the epididymis and secured using some initial stitches two double armed
