Page 116 - January 2021

EQUINE HEALTH
Most owners of a cryptorchid opt to have the retained testicle removed.
A testicle retained in the abdomen is usually very soft and smaller than normal. The inguinal ring doesn’t have to be opened very much to get these out, he says. “If you do have to open it, you must make sure none of the small intestine comes out through that hole. If that happens, you must suture the external ring closed,” says Yarbrough.
In earlier years, surgery to find and remove
an abdominal testicle could be quite risky for the horse. If the veterinarian didn’t find the testicle within the flank, the incision was enlarged enough to reach a hand into the abdominal cavity, perhaps as far as into the area where the testicles were origi- nally formed. Many of these retained testicles have moved within the abdomen, however, and it can take a lot of searching to find them. The farther up in the abdomen and the more difficult to find, the riskier the surgery. It might take the veterinarian several hours to try to find the retained testicle if
it has migrated some distance from the site of the internal inguinal ring.
With laparoscopy, this is easier and safer, and very helpful in cases where the testicle is difficult to find. A laparoscope can be inserted through a small incision in the abdomen, into the peritoneal cavity, and the testicle can also be brought out through this small incision after it is located. “It’s not as invasive, and it’s visual. You don’t have to open the abdominal cavity, as was done in the past,” says Tibary. Making an incision large enough to put your hand into the abdomen to fish around for the testicle can be hard on the horse, to the point that some horses get peritonitis and die.
Many equine surgeons today are very good at laparoscopy and some do quite a
few of these surgeries. In some cases, the procedure can be done with the horse stand- ing, just sedated - which makes less stress on the horse. Laparoscopic surgery is a bit more time consuming than a routine traditional surgery, if the horse is on his back and anes- thetized for the laparoscopy. The surgical table is tilted a little, so the abdominal contents fall forward, away from the area to be explored, and the abdomen is also inflated like a balloon to do the laparoscopic exami- nation. “This all takes more time; a typical case will take about 45 minutes to an hour, depending on how long it takes to set up. In a standard surgery, by contrast, we can be done in 15 to 20 minutes,” says Yarbrough.
If the laparoscopy is done standing,
time and cost may be comparable for the
two procedures, because you won’t have the added cost of anesthesia. As a rule, however, a laparoscopic procedure will cost more, just be- cause of the cost of the equipment being used. But in a complicated case, the laparoscope can save time and stress on the horse.
“If a veterinarian has already explored the inguinal canal and could not find the testicle, or maybe removed one testicle and came back later to do a hormone profile to see if there is another one inside and has proven that there is, that’s usually when we go in with the laparo- scope,” Yarbrough he says.
Those cases can be done standing if there
is no descended testicle to remove at the same time. If the horse has both testicles retained, or has already had the descended testicle removed, it’s easy to do the laparoscopic surgery stand- ing. If there is still a down testicle to deal with, however, it’s usually safer to have the horse anesthetized and on his back because standing castration can be risky, says Yarbrough.
The advantage of having laparoscopy as
a back-up option is that you don’t have to do everything in one setting, he explains. If a veterinarian is exploring the inguinal ring and can’t find the retained testicle, it is feasible to go ahead and remove the descended testicle, then later run a hormone profile on the horse to make sure it’s not a monorchid before looking for a missing testicle. If the assay shows there is another testicle, you can do the laparoscopy to find and remove it on another day.
“The laparoscope allows you to do a much greater exploration, and the area where you remove the testicle is at less risk for evisceration (prolapse of the intestine through the incision). The incision is smaller and in a structure you can suture nicely. If the horse is standing, you pull the testicle out through a region low in the flank. If he’s on his back, you pull it out through the dense muscle and fascia, which you can su- ture and make a more solid closure. The inguinal ring and inguinal canal structures (that you go through to find the testicle in a traditional sur- gery) are riskier to suture,” explains Yarbrough.
Sometimes a cryptorchid is gelded, removing the one descended testicle and leaving the other. The retained testicle must be removed. There is also some risk for a retained testicle in the abdomen to become tumorous as the horse gets older.