The Clock Was Ticking: Immediate Microsurgical Vasovasostomy for Iatrogenic Vasal Transection During Complex Inguinal Hernia Repair—A Case Report

Background: Iatrogenic vas deferens injury during inguinal hernia repair, though rare (0.3–0.5%), carries significant fertility implications if unrecognized. Rates increase in complex or recurrent hernias. Immediate microsurgical reconstruction is the gold standard for preserving reproductive potential. Case Presentation: A 37-year-old man with a chronic right inguinoscrotal hernia underwent elective open herniotomy. During dissection, a 1.2–1.5 cm longitudinal transection of the vas deferens occurred. The injury was identified intraoperatively. Intervention: Immediate microsurgical vasovasostomy was performed using an operating microscope (ZEISS) under 12× magnification. A tension-free, double-layer anastomosis was completed with 9-0 polypropylene suture. Outcome: The patient recovered without complications. His wife conceived spontaneously five months postoperatively, demonstrating functional patency. The case underscores the importance of immediate repair and intraoperative urological collaboration in high-risk hernia surgery.