Complications associated with closed castration using the Henderson equine castration instrument in 300 standing equids

Abstract

Objective: To describe a closed castration technique in standing equids, report associated complications, and identify potential risk factors. Study design: Prospective cohort study of 300 standing equids that were castrated with the Henderson Equine Castrating Instrument. Methods: Thirteen participating veterinarians recorded intraoperative difficulties and postoperative complications. Descriptive statistics, univariate analyses with Fisher's exact tests, and logistic regressions were used to evaluate intraoperative difficulties and postoperative complications and to assess risk factors for postoperative complications. Results: Data were collected on 300 equids (269 horses, 23 ponies, and 8 donkeys). Intraoperative difficulties were experienced in 39 of 300 (13%) procedures. Postoperative complications were reported in 69 of 300 (23%) equids, including excessive swelling (29, 9.67%), surgical site infection (SSI; 27, 9%), severe hemorrhage (3, 1%), and prolapse of the omentum (2, 0.64%). Donkeys were at increased risk of severe hemorrhage (2/8, 25%, P = .0019). Equids that were castrated in a hospital setting (83/300, 27.66%) more frequently developed excessive swelling (P = .0034, odds ratio [OR] = 3.20) and SSI (P = .0047, OR = 3.18) compared with equids that were castrated in a field setting (217/300, 72.33%). Prolonging antimicrobial prophylaxis or age of the equid at the time of castration had no effect on the prevalence of excessive swelling or SSI. Conclusion: The method of castration evaluated here resulted in a similar prevalence of postoperative complications to that previously reported for castrations in standing horses but fewer SSI. Clinical significance: The described method provides a viable option for castrating horses and ponies, but is not recommended in donkeys.

A review of prevention and management of castration complications

“…Intraoperative risk factors include breaks in sterility, difficult surgical access, intrascrotal or tunic haematomas, poor surgical technique, poorly functioning emasculators or inappropriate emasculator use (Hodgson & Pinchbeck, 2019;Mason et al, 2005;Schumacher, 2019) Instrument is a pliers-like instrument attached to a power drill, that twists the spermatic cord, rather than cutting, resulting in sealing the severed vessels. In one report using the Henderson emasculators, haemorrhage was not reported as a complication (Hinton et al, 2019) and in another only 1% (3/300) cases had postoperative haemorrhage (Racine et al, 2019) and 2 of these cases were in donkeys.…”

“…The Henderson Equine Castrating Instrument is a pliers‐like instrument attached to a power drill, that twists the spermatic cord, rather than cutting, resulting in sealing the severed vessels. In one report using the Henderson emasculators, haemorrhage was not reported as a complication (Hinton et al, 2019) and in another only 1% (3/300) cases had postoperative haemorrhage (Racine et al, 2019) and 2 of these cases were in donkeys.…”

Surgical antimicrobial prophylaxis: Current standards of care

“…Antimicrobials are not routinely used by some surgeons for castration (David Levine, personal communication) (Crandall et al, 2020;Hinton et al, 2019) with a complication rate that is no different to the reported complication rate of 10% (Kilcoyne, 2013). In two other studies, prolonging antimicrobial prophylaxis had no effect on swelling or infection (Racine et al, 2019) and horses receiving prolonged SAP (days) had a complication rate of 60% (Rosanowski et al, 2018). While there is no strong evidence either way, SAP for castration is likely unnecessary.…”

Standing laparoscopy combined with a conventional inguinal approach to treat extended septic funiculitis in 12 horses

“…Some of these, such as haemorrhage, severe infection or evisceration are major or life‐threatening complications, requiring hospitalization. The infection rate after castration ranges from 2‐20% and in one study up to 36.7% after a standing open procedure 1–10 . Septic funiculitis occurs from the extension of a scrotal infection, and a chronically infected stump with pyogenic bacteria is defined as a “scirrhous cord.” 11 The initial surgical incision may completely heal in chronic cases of funiculitis, although the infected stump will continue to enlarge and an abscess with eventualmay produce a draining tract may develop 4,11–12 .…”