La Surgery Packet 8-B

Front 1

chars inguinal hernias in domestic animals

Back 1

usually indirect hernies (the intestines pass through the vaginal ring)

Front 2

chars acute irreducible inguinal hernias

Back 2

- most commonly a breeding problem in stallions
- seldom occurs in other farm animals
- requires emergency surgery and usually resection and anastomosis of incarcerated bowel

Front 3

CS acute irreducible inguinal hernias

Back 3

- acute abdominal pain (as in other GI obstructions)
- careful rectal exam reveals intestine passing through the internal inguinal ring
- scrotum usually distended and sometimes intestine can be palpated in the scrotum

Front 4

chars congenital scrotal hernia of the newborn

Back 4

- considered an inherited trait so the animal should not be retained as a breeding animal

Front 5

CS congenital scrotal hernia of the newborn

Back 5

- palpable enlargement in the inguinal area
- intestine can be forced back through the enlarged inguinal rings

Front 6

congenital scrotal hernias in foals

Back 6

- many are self-correcting with time and increased muscle tone
- usually helps to apply a truss to maintain pressure over the inguinal area
- if the hernia persists it should be corrected surgically

Front 7

congenital scrotal hernias in calves

Back 7

uncommon

Front 8

congenital scrotal hernias in pigs

Back 8

- common problem
- apply pressure to the abdomen to see if intestines can be forced through the external inguinal ring
- surgical correction is indicated

Front 9

chars chronic reducible inguinal hernia

Back 9

- no immediate danger of strangulation
- repair is elective
- stallions and bulls have marked reduction in fertility because of increased testicular temperature
- controversy considering the heritability of this problem

Front 10

differentials for chronic reducible inguinal hernia

Back 10

- periorchitis
- mesothelioma
- hydrocele

Front 11

CS chronic reducible inguinal hernia in bulls

Back 11

- hour glass appearance of the scrotum
- bulls are normally those that have been in show condition prior to entering the breeding herd
- very rare to see anything but a left sided hernia in a bull

Front 12

CS chronic reducible inguinal hernia in stallions

Back 12

- some have recurrent digestive problems
- some have slight rear leg lameness

Front 13

Dx chronic reducible inguinal hernia

Back 13

- palpation
- rectal exam

Front 14

surgical techniques for repair of acute inguinal hernia in stallion

Back 14

- anesthesia, prep, position
- incise over external inguinal ring
- dissect to hernia sac
- open vaginal tunic and check viability of intestine
- resect and anastomose if non-viable; increase size of inguinal ring and replace intestines if viable

Front 15

surgical techniques for repair of chronic inguinal hernia in stallion

Back 15

- anesthesia, prep and position
- incise over external inguinal ring
- dissect hernia sac from scrotal fascia
- twist the hernia sac on itself to force intestine into abdomen

Front 16

best inguinal closure

Back 16

- involved unilateral castration
- ligate vascular component of the spermatic cord
- remove testicle
- ligate common vaginal tunic and remove hernia sac
- place cut end proximal to the superficial ring
- close the superficial ring as in an inguinal approach to the abdomen

Front 17

surgical technique for inguinal hernia repair in the newborn foal, pig and calf

Back 17

- foals anesthetised and placed in dorsal recumbency; pigs held by rear legs and surgerised without anesthesia; calves sedated and placed in dorsal recumbency
- incision over superficial inguinal ring
- dissection to free hernia sac
- common vaginal tunic is twisted on itself, from the testicular end, to force the intestine into the abdomen
- in foals it is common to ligate the vascular elements of the cord and then close the common vaginal tunic with a ligature
- in pigs and calves a ligature is placed around the hernia sac containing the spermatic cord
- the common vaginal tunic and spermatic cord are ligated distal to the ligature
- the stump of the spermatic cord is placed proximal to the external inguinal ring
- external inguinal ring is sutures
- skin can be closed or left open depending on the circumstances

Front 18

pre-op considerations for surgical repair of inguinal hernia in the bull

Back 18

- normal procedure is to repair the hernia and retain both testicles; when orchitis or periorchitis is present, unilateral castration, as recommended for a stallion, is indicated
- fast for 48 hours prior to surgery
- position in right lateral recumbency with the left leg flexed and abducted
- general anesthesia or heavy sedation and local anesthesia

Front 19

surgical technique for repair of inguinal hernia in the bull

Back 19

- draped to expose the neck of the scrotum and inguinal area
- incision from 6 cm dorsal to the external inguinal ring to the top of the scrotum
- bluntly dissect out the common vaginal tunic containing the herniated intestine from the inguinal ring to the proximal pole of the testicle
- if a large mass of adipose tisssue is present along the anterior margin of the inguinal ring, it is dissected free (ligate as far proximal as possible and surgically remove the adipose tissue)
- incise the common vaginal tunic and check for adhesions between the testicle and tunic: must be broken down and hemorrhage completely controlled
- return intestine to abdominal cavity
- use 0.6mm nonabsorbable suture to close the inguinal ring inserting the needle from the outside through the medial edge of the external ring starting 2 cm from the posterior apex of the ring and carrying suture forward medial to the tunica vaginalis and inserted through the edge of the IAO from medial to lateral
- pass the suture caudally medial to the tunica vaginalis and again through the edge of the external inguinal ring, from medial to lateral 1cm anterior to the first insertion
- place a second suture in the same manner but in the lateral margin of the ring carrying the suture anteriorly and caudally lateral to the tunica vaginalis
- the two sutures through the IAO should be a minimum of 3 cm apart
- be sure that the hernia is completely reduced and then pull the IAO muscle caudally by tightening the preplaced sutures
- close the incision in the common vaginal tunic with a continuous pattern of absorbable suture
- place an overlapping mattress suture in the anterior portion of the external inguinal ring with 0.6mm nonaborbable suture
- start the mattress suture 2.5cm cranial to the cranial aspect of the external ring
- use 2 cm suture bites taken 2 cm from the edge of the medial and lateral margins of the external inguinal ring
- continue the suture caudally until only 3 fingers can be inserted through the remaining space
- close the subcutaneous tissue with absorbable suture and the skin with non-absorbable suture in patterns of the surgeon's choice

Front 20

post-op care after surgical repair of inguinal hernia in the bull

Back 20

- antibiotics for 5 days (penicillin)
- expect postop edema for up to 10 days
- 60 days postop, if the semen quality is acceptable the bull should be ready for service

Front 21

indications for ischial urethrotomy

Back 21

removal of urethral or vesicular (bladder) calculi in male

Front 22

position for ischial urethrotomy

Back 22

standing with epidural or local anesthesia

Front 23

surgical technique for ischial urethrotomy

Back 23

- pass catheter to ID urethra
- midline incision just below the anal sphincter
- sharply dissect between the retractor penis muscles continue through the bulbospongiosus muscle, the corpus spongiosum and urethra
- enlarge the incision to remove the calculi or allow passage of forceps into the pelvic urethra and bladder to remove a vesicular calculi
- bladder and urethra should be flushed to remove all of the fragments
- wound is left to heal as an open wound

Front 24

post op management and complications with ischial urethrotomy

Back 24

no special care required postop and no complications expected

Front 25

etiologies of injuries to the penis

Back 25

- kicks (commonly occur during breeding)
- movement of the mare during the act of breeding
- jumping and becoming stranded on top of a fence or partition
- poorly managed stallion ring

Front 26

descr: paraphimosis

Back 26

swelling of the penis and prepuce which causes the penis to be retained outside the preputial orifice, occurs in bulls and stallions

Front 27

treatment paraphimosis

Back 27

- manual support manufactured from nylon mesh laundry bag and latex tubing to hold the penis against the ventral abdomen
- massage aided by ointments and/or lubricants
- NSAIDs
- diuretics
- mild exercise
- antibiotics if infection present

Front 28

maintenance of the penis in the prepuce with paraphimosis

Back 28

- if attended promptly and treated aggressively, it is usually possible to manipulate the penis back into the prepuce within 24 hours
- if there are no lacerations, the penis can usually be kept in place by inserting a probang into the preputial orifice (breaks in skin can turn into abscess)
- pad the end of a vaginal speculum with cotton, apply tape over the cotton, place a plastic sleeve over the tape, insert the padded end into the prepuce, hold in place with adhesive tape encircling the abdomen
- penis usually stays in place after several days

Front 29

descr: phimosis

Back 29

swelling of the penis and prepuce which causes the penis to be retained inside the preputial orifice

Front 30

chars phimosis

Back 30

condition seldom occurs in stallions and is fairly common in bulls

Front 31

chars penile paralysis

Back 31

animal loses the ability to retract the penis into the prepuce

Front 32

etiology penile paralysis

Back 32

- phenothiazine derived tranquilisers used in stallions
- failure to adequately treat paraphimosis

Front 33

Tx penile paralysis

Back 33

- replacement of the penis in the prepuce and retention as for paraphimosis
- occasionally retention for a prolonged time will allow return to function
- surgery to retract the penis is indicated if prolonged retention is not effective

Front 34

descr: paraphimosis

Back 34

swelling of the penis and prepuce which causes the penis to be retained outside the preputial orifice, occurs in bulls and stallions

Front 35

indications for reefing

Back 35

remove abnormal growths or scar tissue that do not extend deeper than the dermis

Front 36

treatment paraphimosis

Back 36

- manual support manufactured from nylon mesh laundry bag and latex tubing to hold the penis against the ventral abdomen
- massage aided by ointments and/or lubricants
- NSAIDs
- diuretics
- mild exercise
- antibiotics if infection present

Front 37

maintenance of the penis in the prepuce with paraphimosis

Back 37

- if attended promptly and treated aggressively, it is usually possible to manipulate the penis back into the prepuce within 24 hours
- if there are no lacerations, the penis can usually be kept in place by inserting a probang into the preputial orifice (breaks in skin can turn into abscess)
- pad the end of a vaginal speculum with cotton, apply tape over the cotton, place a plastic sleeve over the tape, insert the padded end into the prepuce, hold in place with adhesive tape encircling the abdomen
- penis usually stays in place after several days

Front 38

position and anesthesia for reefing

Back 38

- sedation and local anesthesia in the standing animal for small lesions that do not require circumferential incision
- general anesthesia with the animal in dorsal recumbency

Front 39

descr: phimosis

Back 39

swelling of the penis and prepuce which causes the penis to be retained inside the preputial orifice

Front 40

chars phimosis

Back 40

condition seldom occurs in stallions and is fairly common in bulls

Front 41

chars penile paralysis

Back 41

animal loses the ability to retract the penis into the prepuce

Front 42

etiology penile paralysis

Back 42

- phenothiazine derived tranquilisers used in stallions
- failure to adequately treat paraphimosis

Front 43

Tx penile paralysis

Back 43

- replacement of the penis in the prepuce and retention as for paraphimosis
- occasionally retention for a prolonged time will allow return to function
- surgery to retract the penis is indicated if prolonged retention is not effective

Front 44

indications for reefing

Back 44

remove abnormal growths or scar tissue that do not extend deeper than the dermis

Front 45

position and anesthesia for reefing

Back 45

- sedation and local anesthesia in the standing animal for small lesions that do not require circumferential incision
- general anesthesia with the animal in dorsal recumbency

Front 46

surgical procedure for reefing

Back 46

- preparation for aseptic surgery
- pass catheter for ID of urethra
- tourniquet is used bu some
- pull penis anterior - umbilical tape snare is suggested
- circumferential skin incisions anterior and posterior to the lesion
- establish a dissection plane
- dissect skin from deeper tissues
- remove the ring of diseased tissue
- close in 2 layers: simple interrupted pattern with absorbable suture for the superficial fascia and non-absorbable suture or monofilament absorbable suture for the skin

Front 47

post-op management after reefing

Back 47

- limit erection in stallions for 3 to 4 weeks
- breeding ring should be applied
- if non-absorbable skin sutures are used they should be removed in 10 days

Front 48

post-op complications after reefing

Back 48

if hemostasis is less than ideal, a hematoma may develop at the surgical site: drainage is indicated

Front 49

indications for amputation of the penis

Back 49

- carcinomas involving structures deeper than the skin
- penile paralysis - Boltz technique is better

Front 50

preop considerations for amputation of the penis

Back 50

prior castration is suggested

Front 51

anesthesia and position for penile amputation

Back 51

general anesthesia, dorsal recumbency

Front 52

technique for amputation of penis

Back 52

- ventral abdomen, penis and prepuce prepared for aseptic surgery
- urethra catheterised for ID
- gum rubber tubing tourniquet (not necessary)
- apply an umbilical tape snare caudal to the gland to pull the penis anteriorly
- the more caudal the site of amputation, the more difficult the surgery
- site of amputation for penile paralysis should be carefully selected to avoid urine scalding or excoriation
- triangular incision approximately 4 cm/side with thr base anterior continued down to the urethra
- urethra split on the midline
- simple interrupted suture started at the apex to approximate the urethra and the skin
- amputate the penis starting at the base of the triangular incision so that the cut edge at the dorsal aspect of the penis is slightly anterior to the ventral cut edge
- ligate branches of the dorsal artert of the penis and the large veins between the deep fascia and the tunica albuginea
- close the stump with 4 bite sutures taken through the urethral wall, the tunica albuginea of the urethral groove, tunica albuginea of the opposite side and skin
- suture placement should be: 1- middle, 2 and 3 bisecting the 2 halves to dissect into quarters and continuing until adequate sutures have been taken to close

Front 53

postop care after amputation of penis

Back 53

- post op hemorrhage is sometimes a problem for several days
- minor dehiscence is not unusual
- dissecting hematomas cause dehiscence
- granulomas and stenosis are a result of inadequate ligation and an inadequate number of skin sutures
- remove skin sutures in 2 weeks

Front 54

post op complications after amputation of the penis

Back 54

when it has been necessary to amputate a considerable amount of penis, it is sometimes not possible for the horse to extend the penis when urinating

Front 55

indications for retraction of the penis (Bolz technique)

Back 55

paralysis of the penis after all efforts to stimulate spontaneous retraction have been exhausted

Front 56

presurgical considerations for retraction of the penis (Bolz technique)

Back 56

- castration at least one month prior
- removal of granulomatous growths if necessary

Front 57

anesthesia and position for retraction of the penis (Bolz technique)

Back 57

general anesthesia and dorsal recumbency

Front 58

retraction of the penis technique

Back 58

- surgical prep of the prepuce, penis, inguinal region and psoterior ventral abdomen
- pass catheter for urethral ID
- 10 cm incision on the midline just caudal to the castration scar
- dissection to the penis
- retract the penis so that the glans is just inside the preputial origice
- ID the preputial reflection
- insert #2 non-absorbable, non capillary suture through the preputial reflection 2 cm on either side of the midline - be sure to avoid the urethra
- place sutures deep but not through to the preputial cavity (palpate)
- pass the ends of the suture through the skin 5 cm on either side of the incision
- tie suture with a bow knot over large tubing (pieces of 1/2" stomach tube)
- drain may be indicated
- repair the initial incision
- after the horse is tanding, adjust the stay sutures so that the glans is just inside the preputial orifice (!)
- remove non absorbable sutures in 2 weeks