Mr. Huang, 25 years old and elegant, has a secret that is hard to tell: he had bilateral inguinal hernia repair in childhood, but he found that there were no spermatozoa in the semen. Through systematic examination, his clinical features were: normal semen volume but no spermatozoa, normal testicular size, normal blood follicle stimulating hormone and testosterone, bilateral epididymal enlargement; ultrasound showed dilatation of the epididymal ducts and scrotal section of the vas deferens; the preliminary diagnosis was obstructive azoospermia and inguinal section of the vas deferens obstruction. How to choose the treatment? Of course, assisted reproductive technology can be used, but the patient faced the problem: if azoospermia, in today’s pre-marital cohabitation is more common, it is difficult for a girl to accept the marriage; moreover, assisted reproductive technology still exists in the reproductive risk, interference with female physiology and other unfavorable factors, so the patient and his family expressed the desire for surgery. In the past, we usually used to explore the vas deferens in the original incision and join the two ends after finding it, but in practice, the broken end could not be found, sometimes the anastomotic tension was too high for good results, and sometimes the broken end of the vas deferens retracted into the posterior part of the peritoneum, which was difficult to be sutured vertically. On the other hand, the purpose of childhood surgery is hernia repair, so will the reopening of the incision lead to hernia recurrence? If that is the case, it can be said that it is a “loss of a lady and a loss of a soldier”. We have many cases of open surgical anastomosis, both the lucky patients who succeeded in having children, there are also failures, and there is also a patient who had sperm in the early postoperative period, but gradually became obstructed again, which is regrettable. The European urology guidelines consider the procedure difficult and recommend direct use of assisted reproductive technology, and the American male infertility guidelines also consider the open anastomosis technique to be suitable for only “some patients”. However, some international scholars have actually tried laparoscopic-assisted vasovasostomy for the treatment of azoospermia after hernia repair and achieved good results. After searching the literature, we performed the first case of laparoscopic-assisted vasovasostomy in China after learning from overseas experience. In short, the vas deferens was freed laparoscopically and pulled out and then anastomosed with the proximal vas deferens. The anastomosis proved to be free of tension, which made the operation process, which used to be extremely time-consuming and laborious in the past, simpler. After the completion of the anastomosis, the blue liquid was seen to come out of the ureter through the probing port by injecting melphalan, and there was no obvious spillage of melphalan at the anastomosis, which fully indicated that the anastomosis was successful, and we were looking forward to the semen results in one month. Combining the international experience and our practical experience, we have reason to believe that laparoscopic-assisted vasovasal anastomosis for the treatment of obstructive azoospermia after bilateral hernia repair will become a concise, effective and highly popularized procedure.