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with primary closure for castration under aseptic recumbent con- ditions and prevented many complications associated with field castrations but used substantial p.o. anti- inflammatory treatment and measurements in p.o. management, indicating the traumatic potential of a scrotal technique. The retrieval of the complete vaginal process through a small
inguinal incision may seem dramatic but is actually non- traumatic. Regardless of whether a small or a larger content is retrieved, it does not influence the SAA value. Since connected with the ingui- nal region and scrotum only by the loose connective tissue of the tunica dartos and the scrotal ligament, retrieval does not result in trauma of larger structures, nor does it compromise any vas- cular supply and is therefore minimally invasive. Haemorrhage (a possible source of inflammation) is considered normal in field cas- trations (Killcoyne, 2013 ), but it is extremely rare in the inguinal approach (Figure 1 ). Even disruption of the vascular supply of the scrotal ligament (gubernaculum remnant) does not cause haemor- rhage in the vast majority of cases, since the vessels are closed by recoiling after being stretched by the disruption. The only remain- ing trauma would be from the small skin incision where trauma to the visible vascular structures can be avoided. The spermatic cord is assessed by blunt dissection of the fat containing loose connective tissue without causing haemorrhage. The scrotum may seem to be the ideal site of incision to reach the testis. However, the scrotum is a specialised thermo- regulating organ with a high density of vascular, lymphatic and muscular tissue which is inevita- bly traumatised by an incision, resulting in profuse haemorrhage. This has actually motivated Keller et al. ( 1996 ) to move the incision from the proximal scrotum (Lowe & Dougherty, 1972 ) to the ingui- nal site and, by doing so, reduce haemorrhage significantly. The closed inguinal approach represents a truly closed castration pro- cedure by keeping the abdominal cavity closed at any time, using no intraperitoneal suture and preventing any blood spilling or other contamination into the peritoneal cavity, which is known to be a source of peritoneal inflammation (Schumacher et al., 1988 ) and a possible source of infection. The inguinal procedure, being a minimally traumatic proce-
dure, with an extremely low inflammatory response requires no routine anti- inflammatory support. Anti- inflammatory medica- tion does not provide intraoperative analgesia, which is suffi- ciently performed by the ketamine–butorphanol combination. Intratesticular and intrafunicular infiltration with 15 mL mepiva- caine (Mecain 20 mg/mL, DK- Pharma) proved previously not to provide reliable intraoperative analgesia, probably since the site of crushing is too far proximal from the site of infiltration. The requirement of p.o. analgesia by anti- inflammatory treatment is rare, but it is applied on indication. The positive relation between age and SAA fits with our observation that older stallions (not included in this study) may show some signs of light abdominal discomfort with increased gut sounds, also mentioned by Kummer et al. ( 2009 ), which subsides with a single i.v. treatment of 1.1 mg/ kg flunixin meglumine (Finadyne RPS, MSD). Avoiding the routine
RIEMERSMA ET AL.
use of anti- inflammatory treatments enables the early recognition of complications, which consequently requires less time in hospi- talisation, making the procedure less expensive and does not delay the healing process. A closed inguinal approach requires a dorsal recumbent posi-
tion in general anaesthesia. The risks of a general anaesthetic pro- cedure in horses are well known (Driessen et al., 2016 ) and these are often used as an argument not to use a recumbent technique, although these come with a lower complication rate (Baldwin, 2024 ; Killcoyne, 2013 ; Mason et al., 2005 ). However, the risks of gen- eral anaesthetic procedures depend on several factors defined by anaesthetic equipment, monitoring and skills, quality of recov- ery and patient- related predisposing factors (Driessen et al., 2016 ; Loomes & Louro, 2021 ; Stick, 2012 ). The quality of monitoring anaesthesia, patient positioning and recovery in the field does not compare with these parameters in a well- equipped surgical facility (Driessen, 2006 ). Individual predisposing factors are rare in the pop- ulation of young healthy horses to be castrated, a surgical procedure (not indicated by a clinical disorder) of only 20 min, and an anaes- thetic duration of only 45 min. These risks have to be weighed by the risks of a standing procedure, which are less well documented, as there are slippering and falling of the sedated horse, trauma and in- creased complications from the surgical procedure, including poten- tially fatal complications, that is, eventrations, requiring emergency surgical intervention and last but not least the possibility of trauma to the surgeon by adverse reactions of the patient. Baldwin ( 2024 ) offers a comprehensive review of measures
to anticipate and prevent the worst complications of castra- tions, which the author uses synonymously for field castrations. However, history shows that complications after field castrations cannot be prevented because it is a surgical procedure under uncontrolled conditions and probably therefore among the main reasons for client complaints and litigation (Maxwell, 2009 ). Infections should rather be prevented by using aseptic surgical procedures than be compensated by anti- bacterial medication, which may show the public good stewardship of veterinarians in terms of preventing antibiotic resistance (Bowen, 2013 ). Post- operative discomfort should be prevented by using minimally invasive techniques instead of anticipated by anti- inflammatory medication. The best prevention of complications in field castra- tions would therefore be to choose an alternative surgical proce- dure, like the closed inguinal approach or a similar technique (i.e. Kummer et al., 2009 ), which should better be discussed with the owner before performing a field castration.
CONCLUSIONS
The findings substantiate the hypothesis that the third- day p.o. SAA value following castration through the closed inguinal approach is significantly ( p > 0.001) and substantially (Cohen ' s d >> 0.8) lower than the corresponding values observed after the mentioned field
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