CLOSED INGUINAL CASTRATION TECHNIQUE COMPARED WITH FIELD CASTRATIONS
four patients (Table 2 ) from the study, however, the high impact of exclusion on the mean value could be considered to bias the objective results. It is also possible that comparable patients may have been in- cluded in the reported field studies. Jacobsen et al. ( 2005 ) excluded patients with elevated white blood cell count but did not select on the pre- operative SAA values which on Day 0 ranged from 10 to 200 mg/L. Busk et al. ( 2010 ) included patients with a pre- operative SAA of <10 mg/L, excluding patients with pre- operative values from 66.8 to 905.7 mg/L. Haucke et al. ( 2017 ) included patients with pre- operative values of <35 mg/L. Bergstrom et al. ( 2021 ) included patients with SAA values <50 mg/L. All four authors described p.o. complications by their patients (Haucke et al. ( 2017 ) 36%, Busk et al. ( 2010 ) 34%, Jacobsen et al. ( 2005 ) 39% and Bergstrom et al. ( 2021 ) 40%), being no reason for exclusion, except infections of the jugular veins, which were excluded by Bergstrom et al. ( 2021 ). Surgical site infections are rare under aseptic surgical conditions,
as has been suggested already by Lowe and Dougherty ( 1972 ), which is an important advantage of the method described in this study and the motivation not to use routine peri- operative anti- bacterial medication. Only one surgical site infection out of 102 incisions was detected in the present study but nevertheless one too many. However, Haucke et al. ( 2017 ) showed that 44% of cultures taken from the incisions directly p.o. were positive, indicating intraopera- tive contamination. Even 100% of the cultures taken from the inci- sions on the third- day p.o. were positive, indicating that wounds left open after surgery will be contaminated p.o. All four authors of the field castration studies left the scrotal wounds open for drainage to anticipate the risk of intraoperative contamination. Contamination predisposes to surgical site infections and accordingly, all four field castration studies reported surgical site infections as the main cause for complications, despite the use of peri- operative anti- bacterial treatments. Since the empty scrotum contracts proximally by the dartos muscle, incisional contamination may reach the distal rem- nants of the spermatic cord, possibly resulting in chronic infections and scirrhous cords. An incisional infection ascending to the prox- imal vaginal pedicle is less likely to occur in the inguinal approach since the pedicle of the proximal spermatic cord is contracted by the cremaster muscle sufficiently away from the inguinal incision. The major advantage of the inguinal approach is the re-
trieval of the intact vaginal process through a small inguinal in- cision, providing easy access to the proximal vaginal process for crushing and ligation. Smaller testis with shorter spermatic cords (pseudo- cryptorchids) can be retrieved just as well. This enables a secure ligation, which is essential in preventing p.o. haemor- rhage and eventrations especially in predisposed horses, such as Standardbreds which are known to have wider inguinal canals (Moll et al., 1995 ). Ligating the proximal vaginal process is prob- ably more secure than the distal part where the development of
( 2017 ) and Bergstrom
| 593
in which a Sand emasculator is used for crushing proximal to the testis whereafter a ligature is applied proximal to the crushing site, removing the Testis by cutting the distal vaginal process just distal to the site of crushing. Bergstrom et al. ( 2021 ), however, applied a cutting emasculator to the closed spermatic cord without ligation, leaving the vaginal cavity open afterwards. Ligating the intact proximal spermatic cord through a scrotal incision necessitates pushing the scrotum away from the distal vaginal process, poten- tially encompassing additional surrounding tunica dartos tissue in the ligature. This may lead to a less secure suture and an increased risk of contamination. Jacobsen et al. ( 2005 ) and Busk et al. ( 2010 ) performed a standing castration using a semi- closed scrotal pro- cedure (Rutgers & Merkens, 1983 ; Schumacher, 2012 ) and applied cutting emasculators for haemorrhage control and testis removal, without closing the vaginal cavity by a ligature. The ligation pro- cedure described by Keller et al. ( 1996 ) proved to be insufficient in two out of 82 cases. Choosing the pre- compressed site for liga- tion, as in this study, results in a kind of trans fixation by form and friction, without perforating the vaginal cavity. The compression caused by the emasculator reduces the moisture content of the spermatic cord instantly at this site resulting in considerable size reduction and a better holding of the ligature. Applying a ligature to an uncompressed site results in the displacement of fluids over time, causing the phenomenon of stress relaxation, a property of visco- elastic structures, by which the ligature may lose its com- pressive force gradually. The suture must include the cremaster artery, since being on the outer surface of the vaginal tunic, it may not be reliably crushed by the emasculator and poses a risk of (non- fatal) p.o. haemorrhage. This may be one reason for p.o. haemorrhage in castrations without ligature to the spermatic cord. The double- strand USP 1 suture combines the better knot security of a thinner suture with the higher tensile strength of a thicker one.
The significantly lower inflammatory response of the closed
inguinal approach is an indication that it may be less traumatic than a scrotal approach in field castrations. Although it remains to be proven whether the third- day p.o. SAA level solely de- pends on non- septic inflammatory causes,
it is feasible that at
the pampiniform plexus increases vascular complexity and tissue diameter (Figure 1 ). Haucke et al.
et al. ( 2021 ) performed a closed recumbent procedure by retriev- ing the intact vaginal process through a scrotal approach. Haucke et al. ( 2017 ) used the technique described by Keller et al. ( 1996 )
least a considerable influence of traumatic origin will contribute to these SAA values. Love et al. ( 2009 ) showed that field cas- trations in ponies resulted in altered behaviour associated with p.o. pain first day after surgery. This indicates an inflammatory response to trauma, since most infections become usually clini- cally significant only some days after surgery (Killcoyne, 2013 ). Furthermore, antimicrobial and anti- inflammatory medication may delay the clinical appearance. P.o. oedema of scrotum and prepuce, indicating local inflammation by vascular compromise, a common complication after field castrations (Killcoyne, 2013 ), is extremely rare (<1%) after the castration by a closed inguinal approach (Riemersma, 2005 ). Less trauma may result from better surgical conditions under general anaesthesia but may additionally depend on the differences between an inguinal and a scrotal ap- proach. Crosa and Desjardins ( 2018 ) presented a scrotal approach
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