Open castration under field anaesthesia

is the optimum technique for small

ponies and foals. Note the very small
testicle, which has been exteriorised
through the incised parietal tunic

Castration techniques
in the horse PETER GREEN

MOST male horses in the UK are castrated or 'gelded' before maturity to reduce or prevent the difficulties
associated with keeping and riding entire male horses. The majority of castrations are performed in
young horses (colts) but, from time to time, mature animals (stallions) also need to be castrated due to
poor breeding performance or demand, change of career, or because of testicular or inguinal pathology.
The choice of castration technique is governed by the age, temperament and size of the horse, the
presence of concurrent abnormalities, the preferences of the clinician or owner and by the facilities
available. This article discusses these factors and describes the procedures involved in both open and
closed castration.
Peter Green
graduated from
Liverpool in 1977 ANATOMY OF THE EQUINE SCROTUM, significant ligamentous structures lie within the scrotum:
and worked for TESTICLE AND SPERMATIC CORD * The proper ligament - which links the caudal pole of
some time in large
animal practice in the testicle to the tail of the epididymis;
north Devon. He In a mature male horse the two testicles are suspended * The ligament of the tail of the epididymis - which
is a partner in an
equine practice in within separate left and right sides of the scrotum, a pre- connects this structure firmly to the parietal tunic;
Cambridgeshire, pubic pouch of thin, almost hairless skin. The layer * The scrotal ligament - which joins the parietal tunic
which he established
in 1990. He obtained immediately beneath the scrotum is the tunica dartos to the skin at the base of the scrotum.
the RCVS certificate in which consists of loose connective tissue and diffuse The blood vessels and nerves to and from the testicle
equine orthopaedics involuntary muscles which vary the size of the scrotum are gathered together into a bundle (the neurovascular
in 1992 and is an
examiner for the in response to temperature. A median raphe on the cord within the tube of the vaginal process) and enter the
RCVS certificates in testicular skin continues internally as a median sagittal inguinal canal. This entire tubular structure and its con-
equine surgery.
septum from the tunica dartos and divides the two scrotal tents is known as the spermatic cord. On the exterior of
pouches. Deep to the tunica dartos lies the tunica vagi- this cord, at the caudolateral aspect, there is a long slip
nalis communis which is a distinct membranous sac of the internal abdominal oblique muscle (the cremaster
derived from the embryonic outpouching of the parietal muscle) which runs along the outer surface of the
peritoneum. This pouch is known as the vaginal process parietal tunic and attaches to the tunic at the caudal pole
and is continuous with the parietal peritoneum within the of the testicle. This muscle retracts the testicle.
abdomen via the inguinal canal. The vaginal process nor-
mally contains the testicle together with the epididymis DESCENT OF THE TESTICLE
and associated structures and a few drops of peritoneal During gestation, the testicle develops caudal to the kid-
fluid. The left and right vaginal processes are completely ney and, by about five months of gestation, is almost the
separate. The testicle itself, together with the epididymis, same size as a testicle of a mature horse. The gubernacu-
is covered with another layer derived from the embryon- lum is a mesenchymal cord which extends from the cau-
ic peritoneum, the tunica vaginalis propria. In anatomical dal pole of the testicle to the scrotum and acts as a guide
terms, the testicle is therefore no different from the intra- for the descent of the testicle into the scrotum (it is, how-
abdominal organs in that it has a covering of visceral ever, overly simplistic to suggest that the gubemaculum
tunic (tunica vaginalis propria) in moist contact with a draws or pulls the testicle into position). The embryonic
parietal tunic (tunica vaginalis communis). outpouching and development of the vaginal process
Both testicles lie in a craniocaudal orientation, with begins at about 45 days of gestation and, at the five-
the prominent tail of the epididymis at the caudal pole. In month stage of massive testicular hypertrophy, the
most normal mature horses the left testicle is larger than epididymis descends into the process while the testicle
the right and hangs slightly lower in the scrotum. Three remains in the abdomen. During the last half of gesta-

250 In Practice * MAY 2001

tion, the testicle atrophies and the gubernaculum short-
ens in length, but expands greatly in diameter, opening
the vaginal ring and inguinal canal. This, along with
increased intra-abdominal pressure, allows the testicle to
descend into the vaginal process at about 290 days of
gestation, although it cannot occupy the scrotum because
of the expanded gubernaculum.
At birth, most testicles are external to the vaginal and
internal inguinal rings and lie within the inguinal canal.
(The swollen gubernaculum may be mistaken for a testi-
cle in the immediate postnatal period.) Full descent of
the testicles into the scrotum usually occurs within the
first few weeks of life. It is impossible for a true intra-
abdominal retained testicle to pass through the vaginal
ring after this stage, although testicles within the
inguinal canal may fully descend as late as two years of
age. The three ligaments of the scrotum, epididymis and
testicle, which link the caudal pole of the testicle to the
base of the scrotum via the tail of the epididymis and the
parietal tunic (see earlier), are all persistent remnants of
the gubernaculum.
OPTIMUM TIMING FOR CASTRATION
AGE
There is no firm rule for determining the optimum age
for castration. Secondary sexual behaviour is likely to
become problematic when a colt is over 10 months old
and castration before this age may be indicated; rapid
testicular growth and increased androgenic activity occur
Anatomy of the equine scrotum, testicle and spermatic cord
In Practice e MAY 2001
at 12 to 18 months of age. The age at which castration is
performed will influence both the character and confor-
mation of the adult horse as testosterone has a significant
effect on closure of the growth plates, development of
the crest and shoulders and also on temperament.
Castration of a foal may therefore result in a taller adult
because the growth plates will close later, but this horse
will have less girth of neck and less 'presence' than a
similar animal castrated as a three or four year old.
There is no evidence to suggest that castration influ-
ences eventual athletic performance. However, for
certain disciplines, the age of castration may be more
crucial. Clearly, thoroughbreds, standardbreds and other
racehorses may need to be proven as young entires
before deciding which animals should be castrated in
training yards; the presence of large numbers of colts is
routine and poses few problems to professional horse-
keepers. In dressage, castration may be delayed to
encourage the 'presence' which goes with extravagant
paces, although careful timing of castration is necessary
to prevent the development of a thick neck, which may
limit a correct outline. For pleasure horses and general
riding horses, castration during foalhood or at the year-
ling stage is probably the most sensible choice as it pre-
sents few risks to the animal and eliminates early on the
potential problems of stallion behaviour.
There is no doubt that risks associated with castration
increase with the age of the horse. If the horse has
no future breeding prospects and does not rely on sec-
ondary sexual characteristics for performance or career,
there is no reason to delay castration beyond three years
2251

I.mocLil
* v . 6l6o '
M OR
Premedication/sedation dose per kg
Xylazine 1.1 mg iv
Romifidine 60 pg iv
Detomidine 20 pg iv } plus ketamine 2-2 mg iv giving a bolus of 50 per cent of
Guaiphenesin 20 to 50 mg
(to effect ataxia)
iv Intravenous
of age. The castration of mature stallions carries a
greater risk of complications irrespective of the tech-
nique employed.
SEASON
In the UK, it has been traditional to castrate colts during
the spring and autumn to avoid the presence of flies,
contamination by winter mud and the disruption of
haemostasis associated with hard frosts. This is sensible
in the case of field castration where skin wounds are not
sutured. However, castration in aseptic conditions with
skin closure may be undertaken at any time, subject to
the horse being able to exercise after surgery.
PREOPERATIVE ASSESSMENT
OF THE COLT
With the animal properly restrained by a competent
assistant, the colt should be routinely examined. In
young animals, the precastration assessment may be the
first occasion that the heart is auscultated. If there are no
indications to abandon the castration, it is essential that
careful palpation of the scrotum is performed. Young
animals may require a twitch or sedation for this.
The presence of both testicles in the scrotum should
be confirmed. The safest position for this procedure is to
stand at the shoulder of the colt and reach backwards up
into the inguinal area while the other arm is placed over
the withers to keep the examiner close to the horse's
flank. Colts that resent this palpation or are very lively
when the inside surfaces of the thighs are touched are
not good candidates for standing castration. The palpa-
tion should also include assessment of the scrotum and
inguinal structures for evidence of herniation; large
inguinal rings and inguinal hernias are not uncommon in
warmbloods and draught horses. Some veterinary sur-
geons advocate palpation of the internal inguinal rings
per rectum to assess the risk of postcastration eventra-
tion; however, in the author's experience the presence of
normal or even small internal inguinal and vaginal rings
does not preclude this serious complication.
Drug Dose per kg Comments
Xylazine 1.1 mg 20 minutes adequate sedation
Romifidine 80 pg 30 minutes to 1 hour good sedation
with little ataxia
Detomidine 40 pg 30 minutes to 1 hour good sedation,
although ataxia may occur
NB The doses above may be halved if combined with
butorphanol at 25 pg/kg. This combination provides
increased analgesia and reduced ataxia
IWN' yx&4m
--
Induction dose per kg Comments
Diazepam 0.1 mg Anaesthesia may be prolonged by
the sedative dose plus 50 per cent
of the ketamine dose combined
Thiopentone 4 mg
Ketamine 2 mg
252
RESTRAINT FOR CASTRATION
Horses may be castrated in either the standing or recum-
bent position. If standing castration is not deemed sensi-
ble (see box), the veterinary surgeon has to decide
whether to castrate the horse in the recumbent position
under field conditions or whether to admit the animal to a
clinic with full surgical facilities for castration in theatre.
SEDATION FOR STANDING CASTRATION
Standing castration is usually undertaken with the horse
sedated, although exceptionally quiet well-handled colts
may be castrated under the influence of a twitch and
local anaesthetic infiltration only. More commonly and
more sensibly, standing castration is performed after the
administration of an alpha2-adrenergic agonist, with or
without a concurrent synthetic opiate (see top table,
below left). The author prefers a combination of romifi-
dine and butorphanol as there is evidence to suggest that
romifidine causes less swaying and ataxia than other
alpha2 drugs. Acepromazine should be avoided because
of the risk of persistent penile prolapse.
For animals undergoing standing castration, full onset
of sedation should be ensured and local anaesthetic drawn
up. The scrotum and inguinal areas should be washed with
a dilute surgical skin preparation, such as povidone-iodine
or chlorhexidine, and copious amounts of water. Washing
with surgical spirit is not recommended as spirit running
down the hindlegs of the animal may elicit an adverse
reaction. Sterile gloves should be worn. The testicles are
grasped firmly and tensed within the scrotum; in young
colts, both testicles may be held together while in larger
animals each testicle must be held in turn. Using a long
fine needle (eg, 5 cm, 21 gauge), local anaesthetic is
injected deep into the substance of the testicle. For small
colts, 15 to 20 ml of 2 per cent mepivacaine per testicle is
sufficient; larger colts and stallions may require up to dou-
ble this volume. As the injection is carried out, the needle
should be withdrawn and the last 5 to 10 ml infiltrated as a
craniocaudal line into the tunica dartos beneath the skin
on the most dependent surface of the scrotum. Three to
five minutes will be necessary for the local anaesthetic to
diffuse up into the spermatic cords from the testicles.
Some veterinary surgeons infuse the anaesthetic directly
into the spermatic cord above the testicle; this requires
lower volumes of local anaesthetic but often causes large
haematomata of the spermatic vessels which may affect
In Practice * MAY 2001
surgery and healing. If cord infusion is performed, a sepa-
rate injection into the tunica dartos will be required to
desensitise the skin. Once the local anaesthetic has been
injected, the tail should be bandaged to prevent contami-
nation of the surgical site.
FIELD ANAESTHESIA
Field anaesthesia may be reliably performed using
alpha2-adrenergic agonist premedication followed by
induction with diaz.epam and ketamine (see bottom table
on page 252). The author's preferred combination is
xylazine, diazepam and ketamine; this provides consis-
tent, reliable, relaxed anaesthesia for 12 to 20 minutes
which is adequate for normal castration. It is important to
ensure that full sedation has occurred before induction is
carried out. At least five minutes should elapse and extra
sedative must be given if the colt is not relaxed and unre-
sponsive with the head at the level of the carpi or below.
When lateral recumbency has been achieved, an
assistant should elevate and protract the upper hindlimb
of the colt, either by standing at the withers and holding
a stout rope hitched around the pastern, or by securing
the rope to a loop around the base of the neck. The
advantage of the latter technique is that the animal may
then be rolled into partial dorsal recumbency.
GENERAL ANAESTHESIA UNDER
THEATRE CONDITIONS
For surgery in clinic and theatre conditions, general
anaesthesia in dorsal recumbency is indicated. For
induction and anaesthetic regimens, the reader is referred
to standard surgical texts.
Castration under general anaesthetic is mandatory
where there is any suspicion of inguinal or scrotal abnor-
mality, where one (or both) testicle(s) is retained in the
inguinal canal or where the temperament of the animal
will not allow safe access to the inguinal area in the
standing position. The author always prefers to castrate
mature stallions of the larger breeds under general anaes-
thetic because of the risk of eventration and because it
enables full surgical closure of all layers, promoting
rapid healing and an early return to work.
SURGICAL TECHNIQUES
There is considerable confusion in the literature about
the terms 'open' and 'closed' castration. More recently
the term 'semi-closed' has been coined. It is generally
agreed that the definitions hinge on the veterinary sur-
geon's treatment of the parietal tunica vaginalis. Some
authors reserve the term open castration for techniques
in which the tunica vaginalis is left open, with a patent
tunnel remaining from the abdominal cavity to the exter-
nal area of the scrotum. Others maintain that open refers
to a castration in which the tunic is incised and the tes-
ticle is exteriorised before any ligatures are applied,
whether or not the tunic itself is subsequently closed by
ligation. Similarly, closed castration may refer to tech-
niques in which the tunic is not opened in any way until
the spermatic cord is ligated, or it may refer to tech-
niques in which the tunic is closed at the end of surgery.
The author prefers to adopt terminology based on
patent access to the abdomen at any stage of surgery.
Therefore, closed castration is a technique in which the
spermatic cord is ligated first, before any tissue within the
vaginal process is incised or removed. This procedure
ensures that there is never any potential access for conta-
mination into the abdomen and no sutures are left within
the spermatic cord. The abdomen is always closed. Open
castration involves incising the parietal tunica vaginalis
before the application of any ligatures or emasculators.

Equipment
For all castrations, a simple sterile surgical kit, includ- immersed in a suitable cold sterilisation solution just
ing sterile swabs and a selection of absorbable liga- before surgery.
tures is required. Polyglactin, polyglycolic acid or
polydioxanone suture materials in 3 and 5 metric
sizes are all suitable.
Emasculators, which are available in various pat-
terns and styles, are useful, but not essential. In the
UK, the 'Serra' pattern is the most popular and wide-
ly believed to provide the best haemostasis. However,
in the author's experience, other patterns are just as
effective. A useful alternative to the emasculator is
the ecraseur which is particularly useful in the stand-
ing castration of smaller colts as it is less bulky and
can be tightened slowly. It can be difficult to sterilise
emasculators in smaller autoclave units because of
their size. Ethylene oxide sterilisation is therefore Four different styles of emasculator. The two on the right
appropriate. Alternatively, the instrument may be are 'Serra' pattern

Use of an emasculator
As an emasculator cuts and crushes, it is absolutely essential that it is used properly. The central joint in the
Serra emasculator and many other models is secured by a wing nut and bolt - the emasculator must be
applied with the flat side facing the inguinal area so that the protruding wing nut is pointing to the testi-
cle ('nut to nut'). Once fully tightened, all emasculators must be left in place on the neurovascular cord for
at least one minute. In larger horses, two minutes is preferable.

In Practice o MAY 2001 255

SIMPLE OPEN CASTRATION BY EMASCULATION
Open castration by emasculation is suitable as a routine
technique for immature colts and may be employed in
either the standing or recumbent animal. The testicle is
tensed within the scrotum and a bold incision is made in
a craniocaudal line at the most dependent curvature of
the scrotum to the left or right of the median raphe. In
recumbent horses, the lower testicle should be operated
on first, while in standing horses the more distant testicle
should be castrated first. It is better to make the incision
more towards the cranial than the caudal pole of the tes-
ticle because the caudal pole is attached to the internal
surface of the tunic by the proper and epididymal liga-
ments. In the case of standing castration, a guarded blade
held between the finger and thumb should be employed
without the use of a scalpel handle as this reduces the
risk of injury to both the operator and patient in the event
of a kick or struggle. The incision is continued through
the tunica dartos, to expose the parietal tunica vaginalis.
It is important that the tunic is not incised until some
blunt finger separation of the vaginal process from the
skin has been achieved. This is performed until the vagi-
nal process containing the testicle is tensed within the
hand and pulled out of the scrotal incision.
The tunic is incised to expose the testicle, and the tes-
ticle is then exteriorised through the incision; it remains
attached to the caudal reflection of the parietal tunic by
the proper and epididymal ligaments. A gloved finger
should be hooked behind the testicle at the caudal pole
and tension maintained through the ligaments and tunic
(pulling directly on the testicle can cause rupture of the
spermatic vessels).
The technique for the removal of the testicle and asso-
ciated structures depends on the size of the horse. In
immature colts, the emasculator may be applied to the
whole of the cord by placing the instrument distally and
sliding, it up the cord until the testicle, epididymis and
distal vaginal process are isolated by the Jaws. It is
important that the emasculator is applied transversely,
since the haemostatic crushing effect is reduced by
oblique application. It is also essential that no skin is
included in the Jaws. In larger animals, once the testicle
In recumbent colts the use of two emasculators
may be more efficient
256
has been exteriorised, the mesorchium should be pene-
trated with the finger and the neurovascular element of
the cord isolated. This is emasculated first, leaving the
testicle suspended by the musculofibrous cord consisting
of ligaments, vaginal tunic, cremaster muscle and ductus
deterens. If the neurovascular cord is emasculated sepa-
rately, there may be moderate haemorrhage from the ves-
sels on the isolated testicle. After proper emasculation of
the neurovascular cord, the musculofibrous cord should
be tensioned and emasculated; there is no need to leave
the instrument in place on the neuromuscular cord for
more than a few seconds. It is important to remove as
much of the tunic and cremaster muscle as possible as
any remaining tissues are prone to swelling, exudation
and infection. The other testicle is removed in the same
way through a separate incision.
The use of two emasculators in recumbent colts will
reduce the length of surgery, although two emasculators
are less useful in the standing colt because the instru-
ments always needs to be supported. It is inadvisable to
leave the clamped emasculator suspended from the
neurovascular cord as the weight of the instrument may
rupture the spermatic vessels high within the inguinal
canal and lead to considerable haemorrhage. This risk is
increased if the colt jumps or kicks as the emasculator is
left hanging.
Once the second emasculator has been removed, the
wound is inspected for excess haemorrhage. Some drip-
ping of blood is normal. The skin is not sutured and the
gelding is allowed to recover from the anaesthetic or is
released from standing restraint. The main advantage of
the simple open technique without ligation is that, given
the limitations of the field situation in which a rigid
aseptic technique is difficult, the risk of postoperative
sepsis is low. The reason for this is that, in a correctly
performed castration, none of the tissue remaining with-
in the scrotum or inguinal canal will have been handled
and no foreign material is introduced. All tissues which
are handled by the surgeon, with the exception of the
scrotal skin, should be removed.
Modifications
Some veterinary surgeons remove an elliptical portion of
skin from the base of the scrotum before proceeding with
the castration, to increase postoperative drainage. This is
achieved by joining the cranial and caudal commissures
of the two scrotal incisions and excising the intervening
skin. In the author's experience, this is not necessary if
sufficiently large incisions are made in both sides of the
scrotum.
If emasculation is not being employed, the entire
spermatic cord may be clamped, ligated with 5 metric
absorbable suture and then divided. Alternatively, a liga-
ture may be applied above the emasculator to eliminate
the risk of eventration. If emasculators are not available,
the neurovascular cord alone may be ligated with a
3 metric absorbable suture. The musculofibrous cord
may then be divided with scissors after the application of
large artery forceps proximally.
CLOSED CASTRATION
Closed castration is more difficult to accomplish in the
standing horse because good asepsis is not readily
achieved and also because full exteriorisation of the
vaginal process is much easier when the animal is in
rccumibenicy. As the closed technique takes a little longer
In Practice * MAY 2001
 Technique for simple open castration by emasculation

1. Incise the scrotum and

the tunica dartos

2. Withdraw the vaginal

process and incise the
parietal vaginal tunic

3. Exteriorise the
testicle

5. Emasculate the
musculofibrous cord
4. Break down the mesorchium and
emasculate the neurovascular
spermatic cord
A66

In Practice C MAY 2001 257

to carry out and insolves leaxing heavy-duty sutures in
situ, it is much better suited to clinic or theatr-e condi- Semi-closed castration using
tions, using general anaesthesia. the cranial inguinal approach
The skin is incised, as described for open castration.
and the tunica dartos penetrated; it is essential that the
incision is not continued through the tunica vaaginalis
communiis. Once the vaginal process has been exposed,
it is isolated by blunt finger dissection until the whole of
the process, including the spei-matic cord and cremaster
muscle, is free of all adherent connective tissue and fat.
A useful tip is to wrap a sterile swab around the process
on the inguinal side of the testicle and use the swab as a
dry abrasive collar to wipe all tissue from the cord right
up to the external inguinal ring. In large colts and stal-
lions, the pull of the cremaster muscle may be consider-
able and significant tension is necessary to extend the
vaginal process which encloses the testicle away from
the scrotal wound.
When the whole process is isolated, two doubled 5 1. With the horse in dorsal recumbency, the limits of the
external inguinal ring are located by deep palpation
metr-ic absor-bable sutures are placed aroulld the entire
spermatic cord as near to the inguinal ring as possible.
taking care not to include any fat, skin or connective tis-
sue. These are tightened with maximum force and tied.
Although these sutures may be anchored in the tunic or
in the crem:aster muscle, this should not be necessary if
the sutures are tied tightly enough to prevent retraction
of the spermatic vessels within the tubular tunic at this
level. Long suture ends should be left and clamiiped with
a small pair of artery forceps. The whole of the cord dis-
tal to the sutures may then be emasculated or divided
with scissors and the pr-oxiimal portion of the cord
allowed to retract into the inguinal area, with the loose
long suture ends trailing. If no haemorrhage is noted, the
sutures may be cut off short. If haemorrhage is evident,
the sutur-es will enable retriev al of the cut cord.
If the closed technique has been performed under full
aseptic conditions, the scrotal skin may be sutured. The
skin should not be closed in standing or field castrations
where asepsis is doubtful. Closure of the skin may be
achiex ed with a running horizontal mattress suture using
3 metric absorbable mlaterial, or with simple interrupted 4. By gentle traction, the whole vaginal process, including
sutures. Postoperative swelling may be reduced by scro- the testicle, is drawn through the incision. Note the
inversion of the scrotum (at the top of the picture)
tal ablation, in which the majority of the scrotal skin is
remoxred by making a large elliptical excisioni and clos-
ing the skin with a running simple subcutaneous suture
and v ertical mattress sutures in the skin. Scrotal ablation
is best performied in dorsal recumbency to ensure sym-
metr-ical excision and closure. To determine how much
scrotal skin should be remoxved, the surgeon is adxvised to
use towel clips to bring the skin together and assess
accurately the extent of the surplus skin.

Modifications
Semi-closed techniques involve isolation of the v!aginal
process and contents, followed by incision through the
parietal vaginal tunic to expose, but not remove, the
contents. The neurovascular cord is then ligated with 3
metric absorbable material and allowed to retract into the
tubular portion of the tunic. Ligatures are placed around
the whole of the vaginal process proximal to the site of
incision, slipped proximally and tied off as before. The
distal portion of the process, including- the testicle, is
then remoxed by emascLulation or surgical division. T'he
skin may or may not be closed. 7. A small incision is made in the vaginal tunic to expose
The sites of the sureical incisions may be X aried. the neurovascular cord. This is ligated, divided and pushed
back into the inguinal vaginal tunic
Some eterinary sUirgeons pr-eter to push the testicles

258 In Practice 0 MAY 2001

 K,R -'- -Q

2. Under aseptic conditions, a 6 to 10 cm incision is made 3. The spermatic cord is located by finger dissection and
in a cranial direction from the cranial limit of the inguinal retracted through the incision. Note the cremaster muscle
ring on the caudal lateral surface of the cord

5. The scrotal ligament, which joins the caudal portion 6. The cremaster muscle is separated from the spermatic
of the vaginal process to the scrotal skin, is divided by cord and emasculated
emasculation

- M W,
8. The vaginal process is securely ligated and the distal 9. The subcutis and skin are closed routinely with
portion containing the testicle and epididymis is removed polydioxanone suture material
by emasculation

In Practice * MAY 2001 259

forward and incise the cranial boundary of the scrotum;
others remove both testicles through a single median inci-
sion. Such variations are best suited to theatre conditions.
SEMI-CLOSED CASTRATION USING THE
CRANIAL INGUINAL APPROACH
Semi-closed castration using the cranial inguinal
approach (see box on pages 258-259) is the author's pre-
ferred method for the castration of mature stallions and
colts in training. It results in very little postoperative
swelling and allows rapid return to work. In addition, the
risk of eventration is eliminated.
The technique must be performed under fully aseptic
conditions with the colt in dorsal recumbency. After
carefully preparing the inguinal and caudal abdominal
areas for aseptic surgery, the limits of the external
inguinal ring are located by deep digital palpation. A 6 to
10 cm skin incision is made, beginning at the cranial
edge of the external inguinal ring and extending cranial-
ly. Using blunt or finger dissection, the spermatic cord is
located as it courses out of the inguinal ring and a finger
is hooked underneath the cord which is then withdrawn
through the incision by firm traction. Care must be taken
to avoid the large external pudendal blood vessels which
also emerge from the external inguinal ring. At this
level, the spermatic cord is almost surrounded by the
cremaster muscle. Withdrawing the testicle through such
a cranial incision causes the scrotum first to collapse and
then invert as the scrotal ligament (which joins the
caudal pole of the vaginal process and the skin) pulls the
scrotum inside out through the incision. Once the testicle
within the vaginal process is exteriorised, the scrotal lig-
ament is emasculated or divided, allowing the scrotum to
revert back to its normal position. The cremaster muscle
is then bluntly separated from the parietal vaginal tunic
of the spermatic cord and the muscle is either emasculat-
ed close to the inguinal ring, or is ligated and divided.
The vaginal process, which is now free of cremaster
tension, can be extended by gentle traction. A small
(3 cm) longitudinal incision is made on the cranial
surface of the vaginal tunic, closer to the testicle than to
the skin incision, to allow good placement of subsequent
ligatures. The neurovascular cord is then withdrawn,
together with the ductus deferens. The mesorchium is
penetrated and these structures are all ligated with 3 met-
ric absorbable material and divided; the proximal stump
is checked for haemorrhage before returning it to the
All hs whichare to udrgo open castration
should receietetWnus antitoxin (000 to 10,000 iu)
and the open -wounds shoud be dusted with an
antibiotic or fly repellent podd0er such as chlorte-
tracycline (Aureomycin; Fort Dodge) or coumafos/
propoxursulphanilamide (fegasunt; Bayer). Rou-
tine antibitic coverage is a- sensible precaution if
surgical asepsis has been ob compromised
under field 00cditions4, but should not be necessary
for closed castrations in which the skin has been
sutured. Horses with postoperative swelling may
benefit fro a short course of non-steroidal anti-
inflammaoryx mediatilon, such as phenylbutazone
at 44 mgg or carrfen att 07mg/kg.
In Practice * MAY 2001
Indk : of i- 0
Opencastratons are orelikely suffer co'mpliatons than cloed cas
and aseptic theatre su ywi skin closure is 'ast likely to lead t gil
pathology. There is theotillyt a small ri*associated with general anaesth
sia, but the drug combinations suggested for field anaesthesia are extrem*
safe. The author has castrated many hundreds of colts under field conditions
without- anycomplications due to the anaesthei. The incidence of po
tive hemorrhage, infectionand ivl of thewhole v0agi
preis greater in sadidg castrations b there my bea tende to
rush th predure or access maybeticed -
Clients should be advised that veterinary advice should be sought if any; of
the following are noted:
X Haemorrhage that persists for more than four hours
* Swelling of the perineumbiehind the wounds (under the tail)
* Lameness or tffness t ests for more than three days after surg
* Evidence ftissue (of any description) hanging frm the wound
* Depressibn, inappetence or fever during the week after surgery
tunnel of the vaginal tunic. Two 5 metric ligatures are
placed around the whole cord, proximal to the longitudi-
nal incision in the tunic, and slid proximally to tie them
off as close to the inguinal canal as possible. The vaginal
process can then be severed, removing the testicle,
epididymis and remaining vaginal tunic together. After
completing a final check for haemorrhage, the stump of
the vaginal process is pushed back into the inguinal ring.
The cranial placement of the incision means that the
wound may be treated in the same way as a prepubic
paramedian laparotomy incision and can be routinely
closed with subcutaneous suturing and normal skin clo-
sure. The author uses absorbable material in the skin
(3 metric polydioxanone) to avoid the need to remove
sutures later.
This type of semi-closed castration gives rise to very
little swelling and little postoperative depression.
Wounds usually heal by first intention and rapid return
to full athletic function is possible. The author has
castrated large horses of up to 14 years of age using this
technique with excellent results.
POSTOPERATIVE MANAGEMENT
Further reading
DU PREEZE, P. M. (1999)
Following an open castration, the client should be Castration - update on
advised that the wound may drip blood for three to four techniques. Proceedings of the
Annual Conference of the British
hours. The veterinary surgeon should not leave the geld- Equine Veterinary Association,
ing until haemorrhage has been checked to ensure that Newmarket. pp 137-138
there is no stream of blood from the testicular artery. A RAILTON, D. (1999)
Complications associated
horse which has undergone an open castration under with castration in the horse.
general anaesthetic must be examined after it has recov- In Practice 21, 298-307
SCHUMACHER, J. (1999) The
ered and risen to its feet, as the effort of getting up may testis and associated structures.
increase intra-abdominal pressure sufficiently to even- In Equine Surgery, 2nd edn.
Eds J. A. Auer and J. A. Stick.
trate omentum or even bowel. Open castrations and Philadelphia, W. B. Saunders.
closed castrations with open skin wounds will all suffer pp 515-540
from some inguinal and prepucial swelling; clients TROTTER, G. W. (1992)
Castration. In Equine
should be advised that this is normal. These geldings Reproduction.
should be turned out or lightly exercised for seven to 10 Eds A. 0. McKinnon and J. L.
Voss. Philadelphia, Williams &
days after castration, starting on the day after surgery. In Wilkins. pp 907-914
the case of closed castrations with skin closure, primary VARNER, D. D. & SCHUMACHER,
J. (1999) Castration techniques.
wound healing is best achieved by box resting the patient In Equine Medicine and Surgery,
for 48 hours, followed by one week of walking exercise. 5th edn. Eds P. T. Colahan,
A. M. Merrit, J. N. Moore and
After this convalescence period, the gelding may return I. G. Mayhew. St Louis, Mosby.
to work or be turned out. pp 1024-1028
261