Equine Castration PDF April 7, 2022

Equine Castration April 8th, 2022 Example The prognosis for a large colon volvulus: a) Is best improved by giving two bags of IV fluids in the field b) Can only be determined by abdominocentesis c) Is best improved by early diagnosis and referral for surgery d) Is 50% for more than three hours durat...

Equine Castration April 8th, 2022 Example The prognosis for a large colon volvulus: a) Is best improved by giving two bags of IV fluids in the field b) Can only be determined by abdominocentesis c) Is best improved by early diagnosis and referral for surgery d) Is 50% for more than three hours duration e) Is improved 20% by performing a large colon resection Overview Anatomy Technique Instruments Sterility Methods Complications A note about castrations… Routine does not mean simple Common does not mean uncomplicated Elective: important, but not necessary for life Great potential for harm You should do them as much as possible but respect it https://www.woodlandmanufacturing.com/metal-law-sign-scales-of-justice.html Anatomy Testis Spermatogonia Seminiferous tubules Epididymis Body Tail Coils up caudally to become the ductus deferens Anatomy Normal Appearance Ultrasound Anatomy Spermatic Cord Testicular a., n. Pampiniform plexus Ductus deferens Lymphatics Fascia Mesoductus, mesorchium Visceral and parietal layers of the vaginal tunic Anatomy Inguinal Ring Internal Internal abdominal oblique, inguinal ligament External Slit through the external abdominal oblique muscle External Pudendal vessels Cranial, medial aspect of the external inguinal ring 1. urinary bladder 2. internal inguinal ring 3. peritoneum 4. external inguinal ring 5. vaginal tunic 6. internal abdominal oblique muscle 6.’ caudal edge of the external abdominal oblique muscle 7. cremaster muscle 8. rectus abdominus muscle 9. ductus deferens 10. testicular a and v 11. pudendoepigastric trunk 12. caudal epigastric a and v 13. external pudendal a and v. Anatomy Inguinal Ring Internal Internal abdominal oblique, inguinal ligament External Slit through the external abdominal oblique muscle External Pudendal vessels Cranial, medial aspect of the external inguinal ring If you get deep enough, the spermatic cord runs right by these Instruments-Pack Scalpel handle Scissors? Hemostats-Kelly, Crile Needle drivers Emasculators Assembly wrench Towel Clamps-2-3 Sands Emasculators White Reimer Serra Henderson Prep Can be done with exam gloves/betadine until clean then three repetitions Sterility-Field Not necessary to have separate drapes in the field Triangular, cover the prepuce Small sterile field, keep your hands low Set up your pack before you start CHECK YOUR EMASCULATORS Are they oiled? Are they properly re-assembled? Can you open and close them easily? Sterility-In hospital Multiple, multiple ways Closed Open Modified Open Primary Closure Vasectomy And others… Incision-Younger, Smaller Horses 2 years Tenting the median raphe and cutting cranial to caudal creates two incisions simultaneously to exteriorize the testicles Removes a segment of the scrotum “No Nut-Don’t Cut!!” Exteriorize the testicle Should be able to gently “squeeze” it up out of the incision Can use your fingers to dissect for an inguinal testicle but only dissect laterally-LATERAL IS LEGAL, MEDIAL IS NOT Exteriorize the testicle Clamp the testicle with a towel clamp and provide gentle traction upward Strip the fascia toward the body using either a piece of gauze or by pinching your thumb and forefinger together, the goal is to do it all in one swipe, and you should be able to pull the testicle up more Once done, you may the towel clamp to the client/assistant to hold up Ligation One or two ligatures can be placed around the cord Consider two if the horse is older or the cord is quite large Different ligatures Encircling-Miller’s, constrictor Transfixing Leave long tags and apply a hemostat*** Emasculation Hold fingers around the ligature Guards the suture while cutting Emasculate NUT TO NUT Place the emasculator above your fingers and crush One Down, One to Go With the emasculator on one cord, can start the next Can push the other testicle out (ablation) Or create a second incision through the median raphe or through the scrotum again 2 cm abaxial to midline One Down, One to Go Repeat the above steps If not using ligatures (they are not always necessary) rule of thumb is 2-3 minutes of emasculator time CAREFULLY remove the emasculator from the first testicle, hang on to your hemostat and allow the cord to slide toward the body, observe for hemorrhage, cut the tags when you’re confident Finishing touches Stretch the incisions using your thumb and fore fingers Triple check for bleeding Trim loose tissues that may hang out of the incision when the horse is standing Postoperative Instructions Exercise, exercise! Trotting 10-15 min, 2-3 times a day Some advocate lifting the hind legs and abducting them No exposure to mares/sexual excitement More than one way-modified closed Create an incision through the parietal tunic and use your fingers to turn it inside out to see the testes, epididymis, ductus deferens Evaluate the structures within the sac of the parietal tunic while avoiding infection and hydrocele as with a closed technique This is also a good example for when your extern accidentally nicks the tunic More than one way-Open Open parietal tunic Transect the ligament of the tail of the epididymis Transect the mesofuniculum completely freeing the testis, epididymis and distal portion of the cord, then emasculated Leaves behind the parietal tunic, which could increase the risk of infection Diseases of the cord in which this approach is contraindicated: Neoplasia, periorchitis, torsion of the cord More than one way-scrotal incisions Pulling up on the prepuce and making two parallel incisions over the scrotum Involves grabbing the prepuce Cutting the bottom off the scrotum More than one way-scrotal incisions Some like to cut the skin out from between the two incisions Risk of bleeding The Henderson… SO often misused… Similar complication rates to other castration methods in one study Retrospective; no controls But used by many reputable hospitals and surgeons I’ve used one The Henderson… Keeping everything sterile with the drill Wrapping a sterile towel around your drill handle Having a sterile tool Incorporating the wrong tissue!!! I recommend guarding with your hand just like with the emasculators Minimal tension/pulling Start twisting first Case selection? I’ve used it on donkeys with decent results Donkeys want to bleed-fat tissue, cord Standing Castration Patient temperament Heavy Sedation Good Handler Right Positioning NEVER donkeys They bleed They don’t sleep And they kick at warp speed Standing Castration Incision each side of the raphe 7-15 cm incision Exteriorize Strip the fascia Isolate Ligate Emasculate Complications Hemorrhage Edema Infection Evisceration Colic Hydrocoele Penile damage Excessive Masculine Behavior Hemorrhage First-don’t panic! (Don’t allow the client’s panic to cause you to panic) Where do you think it’s coming from? Is it spurting, dripping or oozing? Is it fresh? Testicular a. bleeding NEEDS to be addressed Superficial bleeders may wait... How much is too much? Under anesthesia is not the same as standing When in doubt, deal with it “Too fast to count” Refer? Hemorrhage-Methods Under anesthesia Blood pressure drops Good control Standing, sedated-working under the horse Difficult to see Can try blind clamping Continues bleeding Gauze packing Must be removed-clot disruption Hemorrhage Standing, sedated-working under the horse Difficult to see Can try blind clamping Continues bleeding Edema Peaks around day 4 21% of horses in once study Excessive associated with infection Needs hard exercise Edema Edema buildup can prevent drainage This can lead to infection Which leads to more edema... Infection Localized In the scrotum ESTABLISH DRAINAGE-BE MEAN! Anti-inflammatories, cold-hosing, exercise Infection Localized Septic Funiculitis Needs surgery-refer, when possible Can easily extend into the abdomen Special names Scirrhous cord –chronic infection with pyogenic bacteria Botryomycosis –Staphyloccus Champignon -Streptococcus Infection-Septic Funiculitis Evisceration Omentum Can be emasculated standing Small Intestine/Viscera Stabilize and refer!!! Can use a clean sheet, wrap up to keep the horse from stepping on them Surrounding tissues Fascia, fat etc.-can be cut with scissors, emasculated Identify the tissue then proceed At Risk Breeds Require Closed Castration Colic More likely in older horses Often a sign of surgical pain Rectal palpation-inguinal rings in case of evisceration Hydrocele Enlargement of the scrotum with fluid Can be surgically removed but is not necessary Penile Damage Avoid medial dissection No nut-don’t cut Identify two descended testicles before dropping the horse when possible Identify them again after prep Push the testicles caudally and distally within the scrotum “Prolonged penile protrusion can result in permanent penile paralysis.” Excessive Masculine Behavior Geldings can display sexual behaviors from interest to even copulation Remember that the epididymis doesn’t produce testosterone 20-30% show continued aggression toward horses 5% toward people hCG stimulation can help determine if there’s heterotropic testicular tissue Tips… Fat tends to have large bleeders NEVER have scissors or a scalpel blade with the tips down in the body where you can’t see them well Maintain asepsis! Implore your clients to follow postoperative instructions Tips… Opening the tunic is not the end of the world-use a towel clamp! Have to be able to recognize what is happening Address the cremaster muscleeither clamp or emasculate it, especially in larger/older horses Do not inadvertently grab any of the fascia/tissues around the cordmay cause tearing Tips… The story of the lacerated scrotum… Sometimes a ligature affords you some sleep at night NEVER a nonabsorbable Donkeys bleed, and bleed and bleed Old horses bleed Standardbreds, Tennessee Walking Horses, and American Saddlebreds, draft breeds are prone to herniation-CLOSED CASTRATIONS PLEASE Questions?