DOUBLE SUBCUTANEOUS TORSION; BISTOURNAGE.
In this mode of operating, principally in vogue in the southern parts of France, the position of the testicle is so changed that its lower extremity is made to take the place of the upper, the cord is subjected to a certain degree of torsion, and then the testicle is restored to its normal position, to undergo a process of atrophy which destroys its power of secretion by a physiological action. The great length of the cord and the greater laxity of the cellular tissue situated between the dartos and the fibrous coat, render this operation much easier in the ruminants than in the solipeds. Simple in its manipulations, although still involving a certain degree of dexterity, and followed by comparatively no symptoms of reactive fever, the only instrument necessary for its performance is a piece of cord, twine, or rubber, sufficiently strong to secure the testicular envelopes when the gland has been subjected to the double displacement, and the cord to the torsion it has undergone. In this operation, no special preparation being demanded, the animal is usually treated on his feet.
The late Mr. Serres, of the veterinary school of Toulouse, divides the operation into four steps, viz., first, the softening of the bags and separation of the dartos from the fibrous tissue; second, the displacement (dislocation) of the testicle; third, the torsion of the cord; and fourth, the pushing up of the testicles into the inguinal region, with the application of the ligature to keep them in place.
Fig. 16 (A).
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Softening the bags—first position of the hands.
Fig. 16 (B).
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Softening of the bags—second position of the hands.
The first step is the most difficult for the surgeon as well as the most painful to the horse, though the contrary is the fact where the subject is an ox. The operator, stationing himself behind the animal, grasps the testicles with both hands ([Fig. 16]) and quickly draws them down into the scrotum. Holding them there with the right hand, with the left he raises the scrotum by the lower part, firmly pulling upon it downwards and slightly from before backwards. The testicles are then moved upward and downward in the sac, carrying with them the fibrous covering. During this time a peculiar crackling sound is heard, which is caused by the tearing apart of the fibres of the cellular tissue lying between the dartos and the fibrous coat. This laceration is sometimes difficult to effect, especially in aged animals, in which case the up and down motion of the testicles will require a greater number of repetitions before the adhesions are torn.
Fig. 17.
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Position of the left hand at the beginning of the second step.
Fig. 18.
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Second step.
The second step consists in the displacement or dislocation of the testicle, which is accomplished in the manner following: The testicles being pushed well upwards in the vaginal sac, one of them, the left, for example, is drawn well downwards with the left hand, which grasps the cord above the epididymis ([Fig. 17]), the thumb resting on the back of the cord, and the remaining fingers in front of it, while the right hand, placed in pronation, pinches the inferior part of the scrotum. Maintaining these dispositions, the testicles are displaced by the simultaneous action of both hands, the left pushing the cord from above downwards and from before backwards, in such a manner as to depress as much as possible the superior extremity of the gland, while with the fingers of the right hand, resting by their dorsal face against the posterior part of the testicle ([Fig. 18]), the inferior extremity of that organ is pushed upwards. Without losing hold of the envelope, the movement of this hand gives way to these opposite and simultaneous pressures, that of the left hand tending to lower the head of the testicle, and that of the right elevating its tail, and the gland is being flexed upon the cord from which it is suspended, backwards and upwards. At the moment when the testicle forms an acute angle with the cord, the thumb of the left hand, resting upon the cord, comes into action to aid in the displacement by making a point d’appui upon the inferior extremity of the organ, which now occupies the superior position, in such a manner that the spermatic gland is placed parallel with the cord. The manipulations are completed by pushing the testicles upwards towards the inguinal ring, to break up whatever adhesions of cellular tissue may remain. This second step of the operation being completed, the two organs are found to be so placed that they are parallel one with the other, the testicle being posterior to the cord.
Fig. 19.
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Third step. Position of the hands when the torsion is about being made.
Fig. 20.
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Third step. Position of the hands during the torsion.
The third step, or that of the torsion of the cord, now presents itself to our notice. To effect this, the testicle must be firmly held at the bottom of the envelopes ([Fig. 19]), the left hand placed forward upon the cord, and the right behind and upon the testicle. The operator then gives to the organ a twist with the right hand by a motion of rotation from left to right and from without inwards, while with the other he draws upon the cord in the opposite direction. The result of this manipulation is to give to the gland half a turn around the cord ([Fig. 20]), which thus becomes displaced and takes a posterior position. By a change in the action of the hands, but a repetition of the same movement, the right hand now acting on the cord, while the left is applied to the testicle, the remaining portion of the motion of rotation is performed, and a complete torsion of the spermatic support accomplished. By repeating this action, of course as many turns of the cord as may be thought necessary, can be secured, two, however, being generally found sufficient, although, in a few instances as many as four or five may be required—never more than that. The length of the cord is the principal controlling circumstance. When these several steps have been completed with one testicle, their repetition is, of course, in order with the other. And when both have been treated, the consummation of the operation is called for by entering upon the fourth step, or that of the application of the ligature.
Fig. 21.
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Position of the testicles and ligature en masse of the bags when the operation is finished.
To accomplish this both testicles are firmly seized with both hands, and pressed upwards as far as possible against the inguinal ring ([Fig. 21]). It is necessary to be very careful to ascertain that they rest on the same level, in order to be secure against the possibility of untwisting. The ligature is then applied by passing three or four turns of it around the scrotal envelopes, immediately below the testicles, with not more than a sufficient degree of tightness to assure it against slipping off.
The symptoms which succeed the operation are not commonly of a very serious nature, and subside within a period of time varying from two to six hours. Following the operation an inflammatory swelling takes place in the bags, and after one or two days assumes large dimensions. The ligature can now be removed, and the animal left to himself, without further treatment, the testicles undergoing a slow process of atrophy readily recognized by their appearance and the position they always thereafter occupy in the vaginal sac.