Page 204 - Manual of Equine Field Surgery

200 MALE UROGENITAL SURGERIES

rosis of the external abdominal oblique muscle. EXPECTED OUTCOME

This incision should be 1 to 2 cm medial to the

superficial inguinal ring and centered over the Cryptorchid castrations vary in the difficulty and

cranial aspect of the ring. The index and middle time required to perform. In general, the time

finger are inserted through this incision and required or level of difficulty cannot be pre-

bluntly through the internal abdominal oblique, dicted preoperatively. Many inguinal cryptorchids

transverse fascia, and peritoneum and into the require little more than routine castrations. Some

peritoneal cavity. The area of the deep inguinal abdominal cryptorchids require significant time,

ring is swept with the finger for either the epi- careful exploration, and closure. Best results come

didymis, ductus deferens, proper ligament, or lig- when the surgeon is prepared for either situation.

ament of the tail of the epididymis (Figure 35-9,

B). Once one of these attachments is exteriorized,

traction is used to exteriorize the testicle from the

abdomen. The testicle is removed by emasculation COMPLICATIONS

or ligation and transection.

The aponeurosis of the external abdominal Complications are similar to those discussed for

oblique muscle is closed with No. 2 or 3 synthetic routine castration. When invasive procedures are

absorbable suture material (Figure 35-9, C). The necessary, the risk of incisional problems and

skin and subcutaneous tissue are closed with No. eventration is greater than for routine castration.

2-0 absorbable synthetic suture material. Additionally, if significant tissue trauma and
manipulation occur during exploration for

abdominal testicles, adhesion formation near the

inguinal ring may cause colic. Using noninvasive

approaches when possible and entering the
POSTOPERATIVE CARE
abdomen through approaches that can be closed

directly (e.g., the modified parainguinal incision)

decrease the risk of incisional complications and

eventration. Rarely, greatly enlarged testicles, ter-

-----~-- atomas, or cystic testicles are identified and

Postoperative Care require removal through an enlarged incision.

Monorchidism is rare but possible. If a

Exercise Restridions: All horses should be stall retained testicle is not identified after a thorough

rested for 24 hours. Further restriction of activity

depends on the approach used and the antiGi- search, two options are available. The horse can

pated incisional healing. Horses that undergo' a be referred for further surgery, preferably

noninvasive approach with minimal dilation of the laparoscopy, or the descended testicle can be

vaginal ring can be allowed turnout after the initial removed and hormonal testing carried out to

24 hours of stall rest and can return to use in 2 confirm the absence of testicular tissue.

weeks. When the superficial ring has been closed,

horses should have stall rest for 24 hours followed

by 1 week of handwalking and 2 weeks of small- ALTERNATIVE PROCEDURES

paddock turnout. When the abdomen has been

entered through a limited parainguinal approach,

horses should have stall rest for 24 hours followed Alternative procedures for removing cryptorchid

by 3 weeks of small-paddock turnout. testicles include invasive inguinal, suprapubic

Medications: Horses should receive a tetanus paramedian, and flank approaches. The invasive

toxoid booster if it has been longer than 6 months inguinal approach involves entering the abdomen

since the previous vaccination. Phenylbutazone through the inguinal canal. This procedure can

( 4.4 mg/kg BID) therapy is provided for 24 hours. extensively disrupt the deep inguinal ring and

Antibiotic therapy is case dependent but typically vaginal ring, which cannot be closed directly.

is given only perioperatively. Therefore, the authors prefer the parainguinal

Other: Recently gelded horses should be isolated approach to the invasive inguinal approach.

from mares for a minimum of 2 days and prefer- Suprapubic paramedian laparotomy has been well

. ably up to l week after castration.

described and is preferred by some authors.6•7