Veterinary Surgery, 14, 1, 2-6, 1985

Castration of Horses with Primary Closure

and Scrota1 Ablation

SPENCER M. BARBER, DVM

Fourteen horses and one pony, 1 to 16 years of age, were castrated with a technique
designed to promote primary healing and ablation of the scrotum following removal of
descended testicles. Twenty-six testicles (10 nondescended, 15 normal descended testi-
cles, and 1 neoplastic descended testicle) were removed. Nondescended testicles were
removed through a skin incision over the external inguinal ring. Descended testicles
were removed, and the scrotum was ablated by excision of the ventral scrotum. All
testicles were removed by emasculation. The common vaginal tunic was not opened
prior to emasculation of the descended testicles, and transfixation liqation sutures were
used in only two horses. All incisions were closed with multiple layers of synthetic ab-
sorbable sutures in the subcutaneous and subcuticular tissues. All incisions healed by
primary intention, and 14 recovered without complications. As a result of incomplete
scrotal ablation, one horse had temporary lameness and swelling of the scrotal area that
resembled the presurgical appearance.

have been developed for the
M A N Y TECHNIQUES
castration of normal and cryptorchid horses.
For years, it was believed that healing had to occur by
second intention.2 Long skin incisions and forced
postoperative exercise were considered important in
providing proper ventral drainage to prevent post-
operative i n f e c t i ~ n . ~ , Excision
~--? of the common vagi-
nal tunic is advocated by some surgeons to decrease
Techniques of primary closure have been developed
and used successfully to castrate normal and cryptor-
chid horses.6,10,11Transfixation of the spermatic ves-
sels was considered important, and no complications
were identified as resulting from their use.6* Inci-
sions for removal of descended testicles were made
between the scrotum and the external inguinal ring,
and the common vaginal tunic was retained.6*10* l1

the potential for serum accumulation and secondary Horses with well-developed testicles had swelling of
infection.2,5The use of transfixation ligatures was as- the scrotal sac for approximately 3 weeks, sometimes
sociated with increased postoperative sepsis.'2 Follow- as large as the original size of the testicle, resulting in
ing removal of cryptorchid testicles, the inguinal canal some client dissatisfaction.10*
commonly was packed temporarily with gauze and the The object of this study was to evaluate a technique
wound was left to heal by second intention,2-5 or the of primary closure of castration incisions using multi-
external inguinal ring and skin were to ple layers of closure, with ablation of the scrotum in
prevent postoperative herniation. horses with descended testicles, in hope of minimizing
The noninvasive technique of cryptorchidectomy postoperative pain, swelling, and enlargement of the
has been shown to be superior to the invasive scrotal area.
technique in retrieving the undescended testicle and in
minimizing postoperative complications.2$l3 Recently, Materials and Methods
the use of packing in the inguinal canal or sutures in
the external inguinal ring has been considered un- The patient group consisted of 14 horses and 1 pony
necessary following the noninvasive technique of that ranged in age from 1 to 16 years. Five horses had
cryptorchidectomy, but skin incisions were left to heal two descended testicles, two had two nondescended
by second i n t e n t i ~ n . ~ testicles, and eight had one descended and one non-
From the Department of Veterinary Anesthesiology, Radiology and Surgery, Western College of Veterinary Medicine, University of
Saskatchewan, Saskatoon, Saskatchewan, Canada.
Reprint requests: Dr. S. Barber, Department of Veterinary Anesthesiology, Radiology and Surgery, Western College of Veterinary
Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N OW0 Canada.

2
 BARBER 3

TABLE 1. Age, Breed, a n d Location of Testicles in Horses

Castrated with Primary Closure Technique

Testicle Location Unilateral or

Horse Bilateral
No. Breed' Left Right Castration

1 1 QH Abdominal Scrotal Bilateral

2 1 Arab Scrotal Inguinal Bilateral
3 2 Arab Scrotal Inguinal Bilateral
4 2 QH Abdominal Scrotal Bilateral
5 2 QH Scrotal Scrotal Bilateral
6 2 Pony Scrotal Inguinal Bilateral
7 2 QH Abdominal PRt Unilateral
8 3 QH Abdominal Scrotal Bilateral
9 3 QH Abdominal Scrotal Bilateral
10 3 QH Abdominal Scrotal Bilateral
11 3 QH Scrotal Scrotal Bilateral
12 3 QH PRt Scrotal Unilateral
13 5 QH Inguinal PRt Unilateral
14 7 Arab Scrotal Scrotal Bilateral
15 16 ASB Scrota14 Scrota19 Unilateral
(right)

* QH-Quarter horse; Arab-Arabian; ASB-American saddlebred.

t PR-Previously removed.
+ Not removed.
9 Neoplastic.

descended testicle. The size of the descended testicles,
except for horse 15 which had a unilateral seminoma,
were judged subjectively to be normal for the horse's
age. The patient data and surgeries performed are
summarized in Tables I and 2 .
The scrotum and inguinal area of each horse was
palpated prior to surgery, and some were examined by
rectal palpation. Castration was performed under gen-
eral anesthesia, with the horse positioned in dorasl re-
cumbency with the hind limbs suspended. The penis
was positioned within the sheath, which was packed
with 4 x 4 gauze pads and its opening closed with
towel clamps. The scrotal and inguinal areas were pre-
pared for aseptic surgery.
For cryptorchid testicles, a 10 cm skin and sub-
cutaneous fascial incision was centered over the ex-
ternal inguinal ring (Fig. 1). Blunt dissection was used
to separate the subcutaneous tissue over the external
inguinal ring, and either the inguinal extension of the
gubernaculum testis or the vaginal process was iden-
tified and grasped with sponge forceps. A longitudinal
incision was made in the vaginal process with Metzen-
baum scissors, and the testicle was exteriorized by
traction on either the gubernaculum testis or vas
deferens and removed by emasculation.
Two types of skin and subcutaneous fascial incisions
were used for removal of descended testicles (Fig. 2):
1) a linear incision extending from the cranial to caudal
pole of the testicle followed by removal of hemi-
elliptical portions of skin from each side; and 2) exci-
sion of an elliptical portion of skin extending from the
cranial to caudal poles of the testicle. The connective
tissue was separated by blunt dissection; the testicle,
within the common vaginal tunic, was exteriorized;
and the connective tissue was stripped from the sper-
matic cord. Two transfixation ligation sutures of poly-
glycolic acid suture" were placed on each speratic cord
in two horses (nos. 3 and 15) prior to emasculation. The
emasculaters? crushed the spermatic vessels proximal
to the point of transection of the spermatic cord and
were applied for 1 minute in horses less than 5 years of
age and for 3 minutes in horses 5 years or older. If
excessive skin was present, resulting in a "pocket" at
the scrotal site, additional skin was removed so that
the scrotum was completely ablated when the skin
edges were approximated.
Closure of the normal and cryptorchid sides was the
same. The subcutaneous tissue was closed with three
or four layers of either 0 or 2-0 polyglycolic acid* and
polydioxanoneS sutures in a simple continuous pat-
tern. The deepest layer was placed directly over the
external inguinal ring following cryptorchidectomy.
Care was taken to avoid incising or ligating the exter-
* Dexon, Davis & Geck, Cyanamide Canada Inc., Montreal,
Quebec, H9X 3N7.
t Serra, Nasco, Guelph, Ontario, N l H 1A8.
i. PDS, Ethicon Sutures Ltd., Peterborough, Ontario, K9J 7B9.
4 CASTRATION OF HORSES WITH PRIMARY CLOSURE

TABLE 2. Number of Horses, Total Primary Results

Closures, Cryptorchidectomies, and Scrotal
Ablation for Each Age Group When discharged from the hospital, all horses had
~~
very slight or no swelling of the surgical sites, and
Age Total Cryptorchi- Scrotal none had enlargement of the scrotal area that resem-
(yrs) Horses Closures dectomies Ablations bled a descended testicle.
Fourteen horses recovered without any observed
1 2 4 2 2
complications, and all 26 incisions healed by primary
2 5 9 4 5
3 5 9 3 6 intention. In horse 14, one incision was inadvertently
5 1 1 1 - not made over the scrotum, and scrotal ablation was
7 1 2 - 2 impossible. This resulted in a unilateral swelling of the
16 1 1 - 1 scrotal area that approximated the size of the removed
Total 15 26 10 16 testicle, and the horse was lame for 1 month before
making a complete recovery. Fourteen owners consid-
ered the primary closure technique superior to other
castration techniques because postoperative lameness
nal pudic vessels. The skin edges were approximated and incisional swelling were absent or very minimal
with a continuous subcuticular pattern of 3-0 poly- and the scrotal sac was eliminated at surgery.
glycolic acid suture on a cutting needle.
AII horses were given tetanus toxoid vaccine post- Discussion
operatively. Two horses were discharged the day of
surgery, eight horses the day after, one horse 2 days The surgical procedure described is simple and re-
after, two horses 3 days later, one horse 4 days after, quires approximately 1 hour for bilateral castration,
and one 7 days after surgery. Limited light exercise which is slightly longer than previously reported for
was recommended for 7 days after surgery. The own- other primary closure techniques.IO," Ligation of
ers were contacted by telephone 2 to 4 weeks after spermatic vessels was considered important in earlier
surgery to obtain subjective information on the horses' primary closure techniques,I0.l1but no complication
convalescence. They were asked to report on lame- occurred in the 13 horses in this series when ligation
ness, incisional swelling, scrotal enlargement, other was not used.
possible complications, and healing of the incisions, The absence of complications and reduced post-
and were asked to compare these results with those operative pain and swelling following removal of non-
previously encountered following castration of normal descended testicles supports the belief that packing the
and cryptorchid horses with other techniques. inguinal canal or suturing the external inguinal ring is
unnecessary following u s e of t h e noninvasive
technique of cryptorchide~tomy.~ In the author's ex-
perience, packing the inguinal canal produces marked

Fig. 1. Schematic drawing of a horse positioned in dorsal re-
cumbency illustrating the location of the incisions for removal of
nondescended testicles (A) and descended testicles (B). The ar-
rows point to the external inguinal ring, and the dotted lines rep-
resent skin incisions.
A B
Fig. 2. Schematic drawing of a descended testicle of a horse
in dorsal recumbency illustrating the two types of incisions used
in scrotal ablation. A. An initial linear incision followed later by
the removal of hemi-elliptical pieces of skin. B. Removal of an
elliptical piece of skin.
 BARBER
Fig. 3. A right-sided view of horse 15 with a serninoma of the right testicle. A. Preoperative enlarged right testicle (arrow). B. Four
days after removal of right testicle. The incision site is at the arrows. Note the complete ablation of the right side of the scrotum and
the absence of scrotal swelling.
incisional and prepucial swelling and accentuation of
lameness for several days. Herniation is unlikely fol-
lowing the noninvasive technique because the vaginal
ring is minimally enlarged. Primary closure of the inci-
sion assures that evisceration cannot occur, but in-
carceration of bowel within the inguinal canal is still a
possibility.
All incisions healed by primary intention with very
minimal incisional swelling. Elimination of dead space
by multiple layer closure of incisions has been shown
to be of prime importance in preventing wound infec-
tions and is more important than minimizing the
amount of suture material placed in the t i ~ s u e s . ' ~
Polyglycolic acid and polydioxanone suture material
were selected because of their strength, absorption by
hydrolysis, and minimal tissue reaction.'j, l6
Ablation of the scrotum was accomplished by liberal
excision of scrotal skin, removal of the common vagi-
nal tunic, and elimination of dead space. Both methods
described resulted in scrotal ablation, but use of an
elliptical incision may result in removal of an insuffi-
cient amount of skin, requiring additional removal of
hemi-elliptical portions of skin to assure complete
scrotal ablation. Emasculation of the testicle while it
was still enclosed within the common vaginal tunic
assured more complete removal of the tunic and de-
creased the opportunity for fluid accumulation within
the scrotal area. With the exception of horse 14, where
a mistake in technique was made, this technique elimi-
nated the postoperative scrotal enlargement seen
commonly by other surgeons.l0*'' In horse 15, liberal
removal of scrotal skin resulted in minimal postopera-
tive swelling (Fig. 3) after removal of a large neoplastic
testicle. Postoperative scrotal swelling following uni-
5
lateral castration can cause degenerative changes in
the remaining testicle."
Primary closure following removal of cryptorchid
and descended testicles resulted in very minimal post-
operative lameness and swelling and immediate elimi-
nation of the scrotal sac. The primary advantages of
the technique described here over those reported pre-
viously are 1) immediate elimination of the scrotal sac,
2) lack of necessity to ligate spermatic vessels, and 3 )
the lack of necessity to suture the external inguinal
ring. The major disadvantage is the slightly longer sur-
gical time required.
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6 CASTRATION OF HORSES WITH PRlMARY CLOSURE
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Abstructs of Current Literature
Castration of Horses and Donkeys with First Intention
Healing
Cox JE
Three hundred and eleven scrotal testes from horses and
donkeys of all ages were removed by a closed castration
technique using an emasculator applied for between one and
four minutes. A ligature of polyglycolic acid material was
transfixed through the external cremaster muscle of 2 I5
testes. The scrotal skin incision was sutured with a continuous
horizontal mattress suture of polyglycolic acid material. Air
was expelled from beneath the skin incision, but dead space
was not sutured closed. The procedure took 8-12 minutes
when performed by the author. Penicillin and tetanus anti-
toxin or toxoid were given to each horse immediately prior to
surgery.
Slight swelling of the inguinal area, scrotum and prepuce
was evident following surgery. Hemorrhage occurred during
or following 12 castrations, eight of which were performed
without ligation. It was concluded that the technique provided
esthetically more acceptable results, and rapid healing and
recovery of the patients.
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Effect of Pre-clotting on Surface Thrombogenicity and
Thrombolic Complications of Dacron Grafts in the
Canine Thoracic Aorta
Gloviczki P, Hollier LH, Hoffman EA, Plate G ,
Trastek VF, Kaye MP
Preclotted and preclotted autoclaved woven Dacron
prostheses were implanted in the thoracic aortas of 31 dogs.
Grafts were harvested 1-4 weeks later and the thrombus free
surface of each graft was calculated. The extent of thrombus
free surface was least in autoclaved grafts preclotted in
non-heparinized blood (72%) or in heparinized blood (78%).
Grafts preclotted in platelet rich plasma and autoclaved had
an 85% thrombus free surface. Regular preclotted grafts or
grafts without preclotting had the greatest thrombus free sur-
face (97% and 99%). No emboli were found in animals with
grafts that were not preclotted or if grafts were preclotted
with platelet rich plasma and autoclaved.
These data suggest that if the risk of severe bleeding in
a fully heparinized patient precludes the use of a woven
Dacron graft without preclotting, autoclaving a graft pre-
clotted with platelet rich plasma appears to be the method of
choice.
Journal o f Thorncic cirid Curdiovtisculur S u r g e r y 1984;
88:253-258.