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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 smaller sutures are then placed into the epididymal tubule after which the epididymal tubule is incised the fluid is again sampled and this time demonstrates the presence of normal sperm once sperm are identified the stitches are then placed inside the lumen of the vas deferens and the vas deferens is tied down to the epididymal tubule additional stitches are then placed to secure the vas deferens to the epididymal sheath for additional strength this final animation demonstrates the post-operative result with the attachment of the vas deferens to the epididymis directly you