The Influence of Suture Type on Postoperative Outcomes in Minimally Invasive Vasectomy

OBJECTIVE: This study compares vasectomy outcomes between Chromic Gut and Monocryl sutures used for fascial interposition in a large cohort of patients undergoing minimally invasive vasectomy. Current guidelines do not recommend a specific suture material for fascial interposition; therefore, this study aims to evaluate two commonly used sutures to help inform surgical practice. METHODS: This retrospective study evaluated 1389 patients who underwent vasectomy by a single surgeon between March 2011 and October 2022. Patients were stratified based on suture type used for fascial interposition: Chromic Gut or Monocryl. The primary outcome was vasectomy failure, defined as the presence of live sperm or >100,000 non-motile sperm/mL on post-vasectomy semen analysis (PVSA). Secondary outcomes included postoperative pain, symptomatic sperm granuloma formation, repeat procedures, and post-vasectomy pain syndrome. RESULTS: Of the 1389 included patients, Chromic Gut was used in 1145 and Monocryl in 244. There were six confirmed failures (0.61%), with no significant difference in failure rate between suture types (p = 1.0). A higher rate of postoperative pain-related follow-up was observed in the Chromic Gut group compared with the Monocryl group (p = 0.045). Additionally, the rate of sperm granuloma and follow-up procedures were higher in the Chromic group, but without statistical significance. CONCLUSION: This large single surgeon series found no statistically significant difference in vasectomy success between Chromic Gut and Monocryl sutures for fascial interposition. However, an increase in postoperative pain-related follow-up was associated with the use of Chromic Gut. Both materials were associated with low failure rates, consistent with published data.