Surgical castration in large dogs: is closed castration safer than open?

PICO question: In large dogs weighing more than 20 kg undergoing elective orchidectomy, does a closed castration technique result in fewer postoperative complications than an open castration technique? Clinical bottom line: Category of research: Treatment. Number and type of study designs reviewed: One randomised, controlled trial was critically appraised. Strength of evidence: Weak. Outcomes reported: The study found that dogs weighing between 3 kg and 53 kg having closed castrations suffered fewer complications up to 10 days postoperatively compared to those having open castrations. Weight of the dog was not a significant factor in complication rate following closed versus open castration. The study reported a greater number of large dogs weighing over 20 kg suffering major complications that needed a medical or surgical intervention. However, the population size of these large dogs was too small to evaluate, with any significance, which technique was safer in reducing the risk of major complications. Conclusion: Regardless of the size of the dog, there is limited, weak evidence that closed castrations lead to fewer postoperative complications compared to open castrations. However, there is insufficient evidence as to whether this applies to large dogs weighing over 20 kg. Furthermore, there is insufficient evidence on whether closed castrations lead to fewer major postoperative complications, defined as those requiring medical or surgical intervention. There is therefore insufficient evidence to justify a change in clinical practice regarding elective castration technique in large dogs. It can be argued that the best available evidence suggests that closed castrations may be safer overall, but further research is needed to evidence this more strongly in large dogs. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient's circumstances and owners' values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.