Evaluation of three ligatures in simulated equine open castration.
Authors: Gandini Marco, Comino Francesco, Caramello Vittorio, Giusto Gessica
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Haemorrhage remains a significant complication following equine castration, making the choice of ligation technique for the spermatic cord critical to surgical outcomes. Gandini and colleagues conducted a randomised, controlled laboratory study comparing three surgical knots—the giant knot (friction-based), modified transfixing knot, and strangle knot (sliding)—by ligating testicular arteries from 60 testes (20 per group) and measuring both the pressure at which leakage occurred and the suture length required for each technique. The strangle knot demonstrated superior haemostatic properties, withstanding a median leak pressure of 735.5 mm Hg compared to 441.3 mm Hg (giant knot) and 419.2 mm Hg (transfixing knot), whilst using only 5 cm of suture material—marginally less than the giant knot's 6 cm and substantially less than the transfixing knot's 9.2 cm. All three knots performed well above physiological pressures, yet the strangle knot's significantly higher leak threshold combined with reduced suture material suggests it offers a more reliable and efficient approach to securing the vascular bundle during open castration. For practitioners seeking to minimise post-operative haemorrhagic complications whilst maintaining surgical efficiency, these findings provide evidence-based support for adopting the strangle knot technique in routine castration procedures.
Read the full abstract on PubMed
Practical Takeaways
- •Use strangle knots for testicular artery ligation during castration—they provide superior pressure resistance and require minimal suture material for reliable hemostasis
- •The strangle knot offers a practical advantage in the field: equivalent or better performance than other methods with less material and simpler technique
- •All three knot types are sufficiently secure for castration, but strangle knots represent the most efficient choice based on this evidence
Key Findings
- •Strangle knots withstood significantly higher leak pressures (735.5 mm Hg) compared to giant knots (441.3 mm Hg) and transfixing knots (419.2 mm Hg) in simulated castration (P < 0.0001)
- •Strangle and giant knots required less suture material (5 and 6 cm respectively) compared to transfixing knots (9.2 cm; P < 0.0001)
- •All three knot types withstood pressures well above physiological levels, indicating adequate safety margins for clinical use