In this severe form of the trouble under consideration, the various steps of the operation demand careful study. Indeed, so common, so serious, and so frequently fatal are the complications which the surgeon may expect to encounter, that many operators habitually discourage the interference with this peculiar violation of normal conditions.
The first two steps of the operation are similar to those which belong to castration in inguinal cryptorchidy. Following on we have for the
Third step, the perforation of the inguinal canal, or the establishment, by the operator, of an artificial communication from without, with the abdominal cavity within. To effect this the surgeon introduces his hand, with the fingers united in the form of a cone, into the external inguinal ring, and carefully forces them upward towards the external angle of the ilium, resting them upon the crural arch. He soon reaches the closed superior inguinal ring, feeling only the peritoneal membrane, where it is readily torn. Then tearing it sufficiently to permit the passage of the entire hand, or as large a portion of it as is necessary, he has reached the
Fourth step, or the seizure and removal of the testicle.—The hand, or three fingers, are then passed into the abdominal cavity, in order to feel for the organ or its appendages, until the location is determined, whether of testicle, epididymis, vas deferens, or blood vessels. These are usually found floating not far from the torn opening of the peritoneum. But if not so readily discovered, the hand must be carried above the neck of the bladder, towards the end of the deferent canal, which must be followed until the epididymis or testicle is found. It is then carefully brought outwards by a slow and steady traction upon the testicle itself, or upon a portion of the epididymis, or even upon the extremity of some of the testicular blood vessels.
Fifth step.—The removal of the organ is always much more safely effected with the ecraseur than by other means. The operation is completed by the application of a suture upon the external wound, in order to guard effectually against the possibility of ventral hernia occurring subsequently.
Abdominal cryptorchids are sometimes treated by removal through the flank—an operation intrinsically more dangerous, as well as less promising of success than that in the inguinal region.
EFFECTS FOLLOWING THE OPERATION OF CASTRATION.
These will vary more or less in extent and severity, according to the method employed in its performance, and in any case they may be considered in two divisions; as primary or immediate, and secondary or consecutive.
Amongst the first phenomena most commonly observed is, of course, a manifestation of pain, characterized by symptoms of colic, exhibited by the animal in a more or less marked degree, being the result of the unavoidable irritation arising from the manipulations practised upon the organs of generation, whose nerves rise from the sympathetic as well as from the cerebro-spinal nervous system; and from the pain excited in the spermatic cord by the pressure of the clamps, for example. These colicky pains, which are more severe under the bloodless method than in those of the other mode, usually subside after the first hour following the operation, and as a rule require but little treatment more than that of the walking exercise. This sort of pain having subsided, the only further trouble likely to be noticed is the local trouble resulting from the lesion to which the testicular region has been subjected. Resulting from this local lesion, as well as from the rough manipulations attending the various steps of the different procedures, a peculiar stiffness will be observed in the motion of the animal. This may be referred either to the local pain proper, to the dragging to which the cord has been subjected, or to the presence of the clamps, which, resting closely in the groin, necessarily more or less impede the action of locomotion.
Hemorrhage may also occur immediately after the operation, either while the patient is still on the ground or as soon as he regains his feet. This may be due either to the solution of continuity at the edges of the wound of the envelopes, or may proceed from the small testicular or the spermatic artery. The first two causes of hemorrhage need not engage our attention, usually ceasing spontaneously, and never being attended with serious inconvenience. It is not so, however, in the case of hemorrhage proceeding from the spermatic blood vessel proper, occurring after those methods of operating which dispense with the closing of the artery by artificial appliances, as is done with the clamp or the ligature, or which may be observed in castration by torsion, cauterization, the use of the ecraseur, or especially by the process of simple excision. Though not necessarily fatal, the hemorrhage in these instances may require prompt and effectual interference by the surgeon for its suppression.