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Pre-Surgical Information

Spaying or neutering your pet is a big step! There is a lot to consider when we are planning your pet’s surgery. Here is some information to help you make wise decisions. Click here . . .

Special Library

Our Special Library is a collection of informative articles on a variety of health topics. Click here . . .

Discharge Instructions

Click here for information on how to care for your pet at home. Click here . . .

Laser Geld Surgery

Gelding is a common operation with an uncommonly high complication rate. Like skinning cats, there is more than one way to do it. There is a way that offers less pain, faster recovery, and a lower complication rate. It's not for everybody, but is is worth reading about.

People have been gelding horses for thousands of years. In the old days, folks would put ropes on a stallion, cast him (which means throw to the ground using ropes, etc.), tie him up, and then remove the testicles with the stallion wide awake, just as is done to cattle, hogs, etc. This was rough, tough, and dangerous. Nobody liked doing it this way much, and it was not all that uncommon for someone, either patient, surgeon, or assistant, to get hurt. As soon as anesthetic drugs made their way into veterinary medicine, they were put to work to chemically cast the equine geldings-to-be. That was back in the first half of the 20th century, and not much progress has been made since then.

If you've ever watched a horse being gelded, the careful observer will note that horses gelded with injectable "anesthetics" often do not seem to be very asleep. They are often awake enough to blink their eyes, wiggle their ears, groan, strain at the ropes, etc. That's because the injectable anesthetics we use are really just what we call induction agents. We use these same drugs in other species, like cats and dogs, and when we use them we do so with the understanding that they are just to "knock the patient down" just far enough to put in a breathing tube and get the real inhaled gas anesthesia going. While some calm horses will get deep enough on the injectable induction agents, many never really go all the way to sleep and are able to feel the procedure to varying degrees. Thus, a geld surgery under injectable anesthetics is very much a timed event, and the surgeon needs to make sure he is done before the patient wakes up all the way.

Because there is almost no way to do sterile surgery like this, the wounds are left open "for drainage." What this means is that the incisions are not sutured, but are left open, and like all cuts exposed to dirt, grime, etc, they become infected to some degree. Because they are on the bottom side of the horse, the pus and crud generally drains out, and they heal in two to four weeks.

At least most of the time they heal. The fact of the matter is that about 20% of them experience some form of complication, either bleeding, excessive swelling, infection, lameness, fever, or even worse. Complications with a geld surgery are the number one reason equine veterinarians get sued in the United States. I guess we just expect more from our veterinarians these days than a 20% complication rate. But 20% it is. A 2005 study involving surgeons at an up-scale surgical facility in the UK doing castrations on expensive Thoroughbred race horses found that 22% of them had complications that required further treatment. An older study involving Dutch veterinarians found that they had an 18% complication rate. Even if there are no complications, the horses have an open, painful, oozing wound between their legs for two to three weeks.

The list of possible complications of an equine castration is quite long. It includes bleeding (which can be minor or not so minor), swelling, wound infection, cord infection, peritonitis, omental prolapse (fat from inside falls out), intestinal eventration (guts fall out), and fluid accumulation. Most of these complications can be resolved, many with fairly simple treatment, but some can be quite serious. Many complications happen because the owner isn't able or willing to exercise the post-op patient. Newly-castrated horses need lots of care and close observation, and this can be quite a burden on the owner. Some complications happen because the patient kicks dirt or worse up inside the wounds. The moral of the story is that seasoned equine veterinarians will tell young veterinarians that if they haven't had a gelding surgery go bad, it's because they haven't done enough of them yet.

There is an alternative. The twenty-first century has brought us an an advance in gelding technology. The CO2 Laser allows

us to use a new technique to geld stallions. We perform the procedure in a sterile environment, with a full scrub and surgical drapes, inside in an operating room. The laser makes incisions with much less bleeding, pain and swelling. Also, we use the real deal anesthesia, inhaled gas, just like we do on all the other species where pain control is a concern. The patients are out all the way, with no blinking, no ear-twitching, no straining, and no groaning. Then, the incision is sutured closed. It has always seemed a shame to me to make a nice surgical incision and then leave it open to get infected. Horses gelded this way need almost no after-care, experience less pain and fewer complications, not to mention the fact that they do not have an oozing open wound between their legs for three weeks.

The complication rate for laser geldings is much lower than the open way. The UK study found a 5% complication rate in the horses they surgically castrated and sutured closed without using the laser. So while closing the incisions does not totally eliminate problems, it certainly reduces them considerably. It does eliminate the possibility of fat or intestines falling out, and it nearly eliminates the possibility of bleeding. The 95% that heal without complications are back to normal in 7 to 10 days. Some folks find this useful as it means fewer days of training missed. Laser gelding can be a real benefit for those horses that are somewhat less "trained" as well, because if a horse doesn't handle well develops post-surgical complications, it can be a real challenge to deal with them.

As far as the horse is concerned, I feel that the horses appreciate the improvements in anesthesia and surgical technique, and especially I think they appreciate not having an open, oozing would between their legs for three weeks. The first patient we performed this procedure on was an eleven-year-old stallion. Gelding an old stallion like this can be hard on everybody. It is not unusual for them to experience severe pain the first few days. I've seen them lie down and groan in pain all the next day. They often swell considerably, and are at a lot higher risk of developing complications. They need lots of exercise and aftercare. The stallion we lasered never even knew he had been gelded. No swelling, not even a little. Minimal pain. No aftercare needed. He was confined to a small corral for 6 days, and that was it. He got antibiotic powder once a day, and never missed a beat.

It costs more to geld a horse the new way. The trade-off is fewer complications, better anesthesia, less pain, quicker recovery, and no open wound to deal with. Currently, in 2009, it costs about $115 to geld a horse the old way and around $400 using the laser. We need to know in advance that you want us to perform the surgery using the laser, because it takes a lot more time and we need to be able to schedule it adequately. We keep the closed castrations overnight as well, so you drop off one day and pick up then next.