double ligation and transection of spermatic cord and vessels.
Figure 18.13 Transected stump of vaginal tunic following inverting suture closure.
Source: Image courtesy Darcie Sidelinger & Heath King.
Figure 18.14 Schematic of inverting closure of vaginal tunic.
Figure 18.15 Ligation of spermatic cord for a closed castration.
Source: Image courtesy of Richard Hopper and Heath King.
Figure 18.16 Scrotal skin incision closed with continuous interlocking pattern.
Source: Image courtesy of Richard Hopper and Heath King.
Postoperative swelling can be reduced by wrapping the scrotum in 4 inches of elastic adhesive tape (Figure 18.17). The bandage should be removed in 24–48 hours. Skin sutures are removed in 10–14 days and the bull can return to service when the spermiogram returns to normal. Normal bulls undergoing unilateral orchiectomy had normal spermiograms by 14 days after surgery [16]. Bulls with unilateral scrotal pathology and transient testicular degeneration of the remaining testicle should be expected to return to normal sperm production approximately 60 days after removal of the diseased or injured testicle [17]. However, if the surgery is performed during the warmer months of the year, normal testicular function may not resume until ambient temperatures moderate.
Figure 18.17 Postoperative bandaging of scrotum to minimize swelling.
Source: Image courtesy of Richard Hopper.
Inguinal Hernia Repair
The two approaches for inguinal hernia repair in bulls are the standing flank approach and the inguinal approach performed in lateral recumbency. The primary advantage of the flank approach is that it does not require general anesthesia. However, not all hernias can be reduced through the flank approach and closure of the inguinal ring must be performed blindly. Utilizing the inguinal approach requires general anesthesia but provides much better surgical exposure and simplifies closure of the inguinal ring. The improved exposure allows for the identification and transection of adhesions between the herniated bowel and parietal tunic and facilitates resection and anastomosis of injured and strangulated bowel. Therefore bulls that present with an inguinal hernia and evidence of abdominal pain should be repaired by the inguinal approach [18].
Standing Flank Approach
The ipsilateral paralumbar fossa is clipped and prepared for aseptic surgery. An inverted L or paralumbar block is used for local anesthesia. The abdomen is then entered in a routing manner and the inguinal ring is identified. The herniated bowel is grasped and traction is applied to reduce the hernia (Figure 18.18). Failure to reduce the hernia by traction at this stage will require transition to the inguinal approach described below. Once the hernia is reduced, closure of the inguinal ring is performed by blindly placing several interrupted sutures or by utilizing the continuous blind suture technique described in Chapter 55. Care must be taken during closure of the inguinal ring to avoid the vasculature entering and exiting the abdomen through the ring. The flank is then closed in a routing manner [17, 18].
Figure 18.18 Resection and anastomosis of herniated bowel removed from inguinal ring by flank approach.
Source: Image courtesy of Richard Hopper.
Inguinal Approach
For the inguinal approach, the bull is anesthetized and placed in lateral recumbency with the affected side up. The upper rear leg must be elevated to expose the inguinal area. The inguinal area is clipped and prepared for aseptic surgery. A 20‐ to 25‐cm incision is made over the inguinal ring (Figure 18.19). The subcutaneous tissues are bluntly and sharply dissected to expose the spermatic cord. An incision is then made in the parietal tunic to expose the herniated tissues (Figure 18.20). The herniated bowel is examined for adhesions or evidence of strangulation. If encountered, strangulated or devitalized bowel should be removed by resection and anastomosis. Adhesions between the bowel and parietal tunic should be ligated before separation [17, 18]. The herniated bowel is then reduced. The decision is made as to whether the testicle on the affected side will be spared or removed. Removing the testicle will prevent postoperative complication that could impact testicular thermoregulation and allows for simplified and complete closure of the inguinal ring.
Figure 18.19 Incision over inguinal ring.
Source: Image courtesy of Darcie Sidelinger and Heath King.
Figure 18.20 Herniated bowel exposed after incising parietal vaginal tunic.
Source: Image courtesy of Richard Hopper.
Closure of the inguinal ring, when the testicle is spared, is accomplished in two stages. The first stage pulls the internal abdominal oblique muscle posteriorly to support and protect the spermatic cord (Figures 18.21 and 18.22). An atraumatic “hernia” needle loaded with #4 non‐absorbable suture is used to take the first bite through the median border of the inguinal ring near the caudal apex of the ring. The suture is passed under the spermatic cord and the second bite is made through the internal abdominal oblique muscle. The suture is then passed back beneath the spermatic cord and through the border of the inguinal ring near the first bite. This procedure is repeated on the opposite side to the spermatic