Changes

=Introduction=

==Introduction==

Reasons for castration include''' behavior control''', '''cryptorchidism''', '''tumour removal''', '''severe trauma''' and '''sterilisation'''. It is generally performed between the ages of '''12 to 18 months'''. Surgery should be performed in the '''early morning''' to allow for observation throughout the day, and ideally carried out in '''Spring''' or '''Autumn''' when fly numbers are at a minimum. It should be performed somewhere that is dry and clean with appropriate lighting.

Reasons for castration include''' behavior control''', '''[[cryptorchidism]]''', '''tumour removal''', '''severe trauma''' and '''sterilisation'''. It is generally performed between the ages of '''12 to 18 months'''. Surgery should be performed in the '''early morning''' to allow for observation throughout the day, and ideally carried out in '''Spring''' or '''Autumn''' when fly numbers are at a minimum. It should be performed somewhere that is dry and clean with appropriate lighting.

Prior to the the sedation or general anaesthetic a '''full clinical exam''' should be performed. A '''scrotal exam''' should  also be carried out to check for the presence of both testicles and any inguinal hernias. '''Tetanus antitoxin''' should be given prior to surgery.

Prior to the sedation or general anaesthetic a '''full clinical exam''' should be performed. A '''scrotal exam''' should  also be carried out to check for the presence of both testicles and any [[Inguinal Hernia|inguinal hernias]]. '''Tetanus antitoxin''' should be given prior to surgery.

==Open Castration==

===Open Castration===

[[File:Castration_horse.jpg|right|thumb|200px|Open castration of a horse (Wikimedia Commons)]]

[[File:Castration_horse.jpg|right|thumb|200px|Open castration of a horse (Wikimedia Commons)]]

A technique where tunics incised and left '''open'''. It is simple to perform and allows a 'no-touch' technique to be employed unless a ligature is placed. However there are greater risks of eventration and infection with this method of castration.

A technique where tunic is incised and left '''open'''. It is simple to perform and allows a 'no-touch' technique to be employed unless a ligature is placed. However there are greater risks of eventration and infection with this method of castration.

This can be performed '''standing''' in well mannered colts or stallions with good scrotal development and no history of swelling in the area. The advantages of the standing techniques are that it is quick to perform and it is relatively inexpensive. However it does pose an increased risk to the surgeon and poor access to the surgical site if the horse or pony is less than 14.2 hands.

This can be performed '''standing''' in well mannered colts or stallions with good scrotal development and no history of swelling in the area. The advantages of the standing techniques are that it is quick to perform and it is relatively inexpensive. However it does pose an increased risk to the surgeon and poor access to the surgical site if the horse or pony is less than 14.2 hands.

Alternatively it can be performed in '''lateral recumbancy'''. The advantages of this method is the low level of risk to the surgeon. It is also beneficial if the testes are hand to palpate in the standing animal. Disadvantages include cost and the risks of a general anaesthetic coupled with a slow recover time.

Alternatively it can be performed in '''lateral recumbancy'''. The advantages of this method is the low level of risk to the surgeon. It is also beneficial if the testes are hard to palpate in the standing animal. Disadvantages include cost and the risks of a general anaesthetic coupled with a slow recover time.

'''Steps''':

'''Steps''':

* check both testicles are present and then sedate or anaesthetise as appropriate.

* Check both testicles are present and then sedate or anaesthetise as appropriate.

* clip excessive hair and wrap the tail.

* Clip excessive hair and wrap the tail.

* perform a surgical scrub on the testes.

* Perform a surgical scrub on the testes.

* Infiltrate the testes with local anaesthetic if standing and rescrub the area.

* Infiltrate the testes with local anaesthetic if standing and rescrub the area.

* Approach the site from the left hand side of the horse.

* Approach the site from the left hand side of the horse.

* Remove the testicle using emasculators:

* Remove the testicle using emasculators:

In the '''young''' animal the '''entire cord''' can be emasculated in '''one maneuver''' but you should ensure their is no haemorrhage before continuing. In the older animal a hole should be made in the mesorchium above the epididymus. Place the emasculator on the '''caudal portion''', incorporating the '''ductus deferens''' and the '''deferens artery and vein''' for the duration of '''30 seconds'''. Then place the emasculator on the '''cranial portion''' and emasculate the '''testicular artery and vein''' for at least '''90 seconds'''. Avoid catching any skin in the emasculators and ensure they are applied transversely without tugging on the cord. Remember to position the emasculator '''nut to nut'''! In '''stallions''' it is possible to '''ligate''' the testicular artery and vein using absorbable sutures to reduce the risk of haemorrhage (however the presence of suture material in the wound clearly increases infection risk).   

In the '''young''' animal the '''entire cord''' can be emasculated in '''one maneuver''' but you should ensure there is no haemorrhage before continuing. In the older animal a hole should be made in the mesorchium above the epididymus. Place the emasculator on the '''caudal portion''', incorporating the '''ductus deferens''' and the '''deferens artery and vein''' for the duration of '''30 seconds'''. Then place the emasculator on the '''cranial portion''' and emasculate the '''testicular artery and vein''' for at least '''90 seconds'''. Avoid catching any skin in the emasculators and ensure they are applied transversely without tugging on the cord. Remember to position the emasculator '''nut to nut''' (meaning that the nut part of the bolt of the emasculator should be on the same side as the testicle, not the body of the horse)! In '''stallions''' it is possible to '''ligate''' the testicular artery and vein using absorbable sutures to reduce the risk of haemorrhage (however the presence of suture material in the wound clearly increases infection risk).   

* Inspect the wound for haemorrhage.

* Inspect the wound for haemorrhage.

* Repeat with the second (left) testicle.

* Repeat with the second (left) testicle.

==Closed Castration==

===Closed Castration===

A technique where the '''tunics are not incised''' but are instead '''removed''' when the '''cord''' is '''transected'''. It is always performed under '''general anaesthetic'''. There is a reduced risk of haemorrhage, eventration and infection when using the closed technioque. In addition the wound tends to heal more quickly and the technique provides good visualisation of the testes and minimal risk for the surgeon. However it is slower to perform, therefore increasing the general aneasthetic risks, and it requires good sterility and general anaesthesia.  

A technique where the '''tunics are not incised''' but are instead '''removed''' when the '''cord''' is '''transected'''. It is always performed under '''general anaesthetic'''. There is a reduced risk of haemorrhage, eventration and infection when using the closed technique. In addition the wound tends to heal more quickly and the technique provides good visualisation of the testes and minimal risk for the surgeon. However it is slower to perform, therefore increasing the general aneasthetic risks, and it requires good sterility and general anaesthesia.  

'''Steps''':

'''Steps''':

* Suture the skin if necessary.

* Suture the skin if necessary.

==Semi-closed Castration==

===Semi-closed Castration===

This employs the same technique as '''open''' castration except that a '''transfixing ligature''' is placed on the '''vaginal tunic'''. The benefit of this is that the risk of eventration and infection are reduced, but it is hard to perform in the standing animal, and as it is not sterile it can result in the trapping of infection within the wound.

This employs the same technique as '''open''' castration except that a '''transfixing ligature''' is placed on the '''vaginal tunic'''. The benefit of this is that the risk of eventration and infection are reduced, but it is hard to perform in the standing animal, and as it is not sterile it can result in the trapping of infection within the wound.

==Laporoscopic Castration==  

===Laparoscopic Castration===

This technique '''leaves the testes in situ'''. The benefits of this technique are the low risk of haemorrhage, infection and eventration. Healing and recovery time post-op are also rapid and there is minimal risk to the surgeon. It is also a good technique to use if the testes are hard to palpate prior to surgery. Disadvantages include the high cost of equipment, a longer surgery time, and the need for an HcG stimulation test post operatively to ensure the surgery has been successful.

This technique '''leaves the testes in situ'''. The benefits of this technique are the low risk of haemorrhage, infection and eventration. Healing and recovery time post-op are also rapid and there is minimal risk to the surgeon. It is also a good technique to use if the testes are hard to palpate prior to surgery. Disadvantages include the high cost of equipment, a longer surgery time, and the need for an HcG stimulation test post operatively to ensure the surgery has been successful.

=Post Operative Care=

==Post Operative Care==

* Appropriate '''observation''' until recovered if the operation was performed under general anaesthetic.

* Appropriate '''observation''' until recovered if the operation was performed under general anaesthetic

* Appropriate '''antibiotic''' and '''anti-inflammatory''' treatment.

* Appropriate '''antibiotic''' and '''anti-inflammatory''' treatment

* '''In-hand walking''' for ten minutes three times a day if stabled.

* '''In-hand walking''' for ten minutes three times a day if stabled

* A '''clean''', '''dry''' and '''comfortable''' environment should be provided.

* A '''clean''', '''dry''' and '''comfortable''' environment should be provided.

* Advise close observation for the following [[Castration - Complications|complications]]: '''Haemorrhage, eventration, evisceration, excessive oedema, infection and hydrocoele'''.

* Advise close observation for the following [[Castration - Complications|complications]]: '''Haemorrhage, eventration, evisceration, excessive oedema, infection and hydrocoele'''.

'''Post op oedema''' is '''normal''' in the horse. If it is not excessive advise cold hosing for ten minutes three times a day and continue in-hand walking and anti-inflammatory treatment. It is also normal for the wound to '''drip a small amount of blood for 3-4 hours''' post-operatively, however this should not be excessive and there should be no stream of blood.

'''Post op oedema''' is '''normal''' in the horse. If it is not excessive advise cold hosing for ten minutes three times a day and continue in-hand walking and anti-inflammatory treatment. It is also normal for the wound to '''drip a small amount of blood for 3-4 hours''' post-operatively, however this should not be excessive and there should be no stream of blood.

=References=

 

==References=

 

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

Green, P (2001) '''Castration techniques in the horse''' ''In Practice 2001 23: 250-26''

Green, P (2001) '''Castration techniques in the horse''' ''In Practice 2001 23: 250-26''

[[Category:To Do - Siobhan Brade]]

 

[[Category:To Do - Manson review]]

[[Category:Surgery]]

[[Category:Expert Review - Horse]]