Manual Reduction of Scrotal Hernias in Stallions: Technique and Outcome Over the Course of 10 Years

Introduction
Acquired inguinal hernias in stallions are almost always strangulating, with immediate treatment necessary to prevent necrosis of the strangulated segment of bowel. the mortality rate can be up to 25% (1,2). the conventional treatment involves an inguinal approach opening the vaginal tunic, examining the viability of the incarcerated intes- tine and reducing the hernia followed by a unilateral or bilateral castration. this approach is often combined with a midline celiotomy to assess the rest of the abdomi- nal contents, to facilitate the reduction of the incarcerated small intestine and to per- form a resection of the incarcerated segment of small intestine if necessary. non-surgi- cal treatment options consist of gentle traction on the bowel per rectum, with or without external massage of the scrotum(1,3) and external massage alone on the stand- ing horse with or without laparoscopic assistance (3,4). Spontaneous reduction during induction and positioning for surgery has also been reported (2).

Since the early years 2000, one surgeon of our practice started a non-surgcial massage technique to reduce indirect strangulated inguinal herniations, with the horse under general anesthesia in dorsal recumbency. from 2003 all surgeons used this technique as a first treatment in an attempt to reduce the strangulated inguinal hernias. until 2004 the abdomen was routinely opened following successful manual reduction to asses the viability of the strangulated intestine. Because the majority of the horses did not need resection, we felt that recovering the horse after a successful manual reduction would be possible without taking undue risks. from 2004, the decision wheter or not to open the abdomen following succesful manual reduction was based upon pre-operative examination of the horse, the duration of strangulation and owners preference. [...]