Surgical castration in dogs: does the incision approach influence postoperative recovery?

In male dogs undergoing surgical castration, does a pre-scrotal approach in comparison to a scrotal approach lead to a superior recovery, in terms of duration of postoperative pain and/or reduced post-operative complications?

Treatment.

Two prospective clinical trials were critically appraised.

Weak.

Woodruff et al. (2015) evaluated postoperative recovery in 206 dogs following surgical castration using a scrotal incision in comparison to 231 dogs using a pre-scrotal approach. Complications observed in order of frequency, included: incisional swelling; haemorrhage; pain; and self-trauma, however, apart from self-trauma, complications were not influenced by incision location. Dogs castrated using a scrotal approach had reduced odds of self-trauma (OR: 0.51, P = 0.04, 95% CI 0.27-0.97). Moreover, mean duration of surgery was faster for the scrotal versus the pre-scrotal approach (3.6 minutes, P<0.01, 95% CI 3.38-3.82 versus 5.1 minutes, 95% CI 4.86-5.41).Miller et al. (2018) evaluated complication rates following open or closed castration using a scrotal approach in 400 shelter dogs under the age of 6 months. Complications involving intra-operative bleeding were not observed, while marginal rates of post-operative events were reported, including peri-incisional dermatitis (2.3%), skin bruising (1.0%), and swelling (0.3%). No self-trauma or rescue analgesia was recorded. In comparing surgical time, the mean duration was 1 minute ± 0.2 minutes in dogs undergoing scrotal surgery, in comparison to canine patients undergoing the same procedure using a pre-scrotal approach, where the mean duration was 3.5 minutes ± 0.4 minutes.

The outcomes of these two studies imply that a scrotal incisional approach in canine castration is at least no worse in the first 24 hours than a traditional pre-scrotal approach and may also reduce mean duration of surgery. However, limitations to the evidence do not permit a firm conclusion and it also remains unclear whether these advantages persist in the longer postoperative period. Further research is needed to confirm initial findings suggested here.