Search Results (143)

As one of the most frequently performed surgeries worldwide, hernia repair addresses a pathological condition caused by muscle weakness and defects in the muscle wall. Despite its prevalence, hernia surgery remains challenging due to complications such as organ occlusion, seroma, persistent pain, tissue adhesions, and wound infection. Surgical meshes have become the preferred choice for abdominal wall hernia repair, aiming to restore the physical integrity and functionality of the musculofascial layers. Although various types of hernia mesh are available on the market to mitigate post-reconstruction complications, none have proven to be a perfect solution for reducing hernia recurrence. In this review, we explore the etiology of hernias, the materials and structures used in designing hernia meshes, and the emerging multifunctional trends aimed at addressing not just one aspect of the complications but the overall range of complications following hernia repair. We discuss strategies to mitigate side effects and establish the characteristics of ideal hernia repair meshes. Lastly, this review outlines future research directions for developing successful hernia repair solutions, emphasizing the need for innovative approaches to enhance patient outcomes and minimize recurrence rates. Full article

Background: Pre-pectoral direct-to-implant breast reconstruction is increasingly adopted after mastectomy because it avoids pectoralis major dissection, reduces postoperative pain, and eliminates animation deformity. However, reconstruction in patients with large or markedly ptotic breasts remains challenging because of skin envelope management, nipple–areola complex (NAC) viability, and implant stability. This study evaluated batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane-coated implant reconstruction. Methods: We conducted a retrospective single-center study of consecutive patients who underwent batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane-coated implant reconstruction between November 2022 and January 2025. Demographic, oncologic, operative, postoperative, and BREAST-Q data were collected. Primary outcomes included complications, oncologic events, and 12-month patient-reported outcomes. Results: Thirteen patients underwent reconstruction, accounting for 18 breasts, with a mean follow-up of 12.85 months. Mean age was 54.5 ± 9.7 years, mean body mass index was 27.0 ± 3.4 kg/m², and mean Regnault ptosis grade was 3.46 ± 0.52. No seromas or oncologic recurrences were observed. One hematoma and one late infection requiring implant removal occurred. Superficial NAC/central flap epidermolysis developed in four patients and resolved conservatively; no full-thickness NAC necrosis occurred. BREAST-Q scores improved significantly in all domains at 12 months, including satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being (all p < 0.05). Conclusions: Batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane implant reconstruction appears safe and reproducible in selected patients with advanced ptosis, with acceptable complication rates and significant improvement in patient-reported outcomes. Full article

Background/Objectives: Nipple-sparing mastectomy with immediate reconstruction is a preferred option for selected patients undergoing prophylactic or therapeutic mastectomy. Optimizing postoperative wound care is essential to support healing, preserve the nipple–areola complex, and prevent delays in oncologic treatments. This retrospective observational study aimed to evaluate the clinical outcomes associated with the use of the NovoX^® Cup medical device in post-NSM surgical wound management, assessing clinical–surgical outcomes and quality of life (QoL). Methods: We conducted a retrospective observational study on 54 patients who underwent NSM with immediate reconstruction at AOUI Verona between January 2025 and January 2026; Novox^® Cup was applied intraoperatively and changed every 48 h according to protocol. Surgeon-reported outcomes were assessed by the skin flap viability scale and the complications by Clavien–Dindo classification. Patient-reported outcomes were assessed via the Wound-QoL17 questionnaire at 7, 30, and 90 days. Clinical outcomes were supported by photographic documentation. Results: Mean age was 51.5 years; BMI averaged 23.9 kg/m². Local complications occurred in 30.4% of cases (infections 12%, dehiscence 10%, seromas 4%). Mean healing time was 15 days, with 87.4% of patients having drains removed by day 14. One patient required surgical revision, and one (1.8%) experienced delayed adjuvant therapy. Wound-QoL17 responses showed minimal discomfort and high satisfaction. Clinical evaluation revealed favorable wound appearance and preserved NAC perfusion within 48 h. Conclusions: Novox^® Cup appears effective in supporting wound healing and NAC preservation after NSM, with high patient satisfaction and minimal treatment delays. Its integration into postoperative care may enhance outcomes and maintain oncologic timelines. Full article

Background: Incisional hernias are a frequent complication after abdominal surgery and may significantly affect patient outcomes. Retromuscular mesh placement using the Rives–Stoppa technique is widely considered a reliable approach for abdominal wall reconstruction, although postoperative complications remain an important clinical concern. Identifying predictors of adverse outcomes may improve patient selection and perioperative management. Methods: This retrospective cohort study included 1262 patients who underwent retromuscular incisional hernia repair. Demographic characteristics, comorbidities, hernia features, operative data, and postoperative outcomes were analyzed. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of postoperative complications. Model performance was evaluated using receiver operating characteristic analysis. Results: The study included 1262 patients with a mean age of 61.5 ± 12.4 years, with a slight predominance of women (55%). The overall complication rate was 19.5%, with seroma (10.5%), surgical site infection (7.0%), and hematoma (3.5%) being the most common events. Hernia recurrence occurred in 6.0% of patients during follow-up. Multivariable analysis identified obesity (p < 0.001), large defect size (W3) (p < 0.001), diabetes mellitus (p = 0.004), recurrent hernia (p = 0.013), and ASA III–IV status (p = 0.038) as independent predictors of postoperative complications. The predictive model demonstrated moderate discrimination (AUC ≈ 0.73). Conclusions: Retromuscular incisional hernia repair is associated with acceptable morbidity and low recurrence rates. Obesity (OR 2.41), large defect size (W3) (OR 2.12), diabetes mellitus (OR 1.89), recurrent hernia (OR 1.67), and American Society of Anesthesiologists (ASA) classification III–IV status (OR 1.54) were identified as independent predictors of postoperative complications. The predictive model demonstrated moderate discrimination (AUC ≈ 0.73), supporting its potential role in clinical risk stratification and perioperative decision-making. Full article

Background: Defects following total parotidectomy represent a distinctive reconstructive challenge. Restoration of facial volume and contour must be balanced with protection of the preserved facial nerve and reliable healing, particularly after extensive dissection and when adjuvant radiotherapy is anticipated. Multiple reconstructive options exist, each involving trade-offs regarding volume, pliability, long-term stability, and donor-site morbidity. We report our early clinical experience using the adipofascial infragluteal perforator (AIGP) free flap for reconstruction after total parotidectomy with skin and facial nerve preservation. Methods: We retrospectively reviewed the results of three consecutive patients undergoing total parotidectomy for parotid tumors, receiving immediate reconstruction with an AIGP free flap, operated between June and July 2025. The flap, based on terminal branches of the infragluteal vessels, was anastomosed to cervical recipient vessels. To address the two-compartment defect created by facial nerve preservation, the adipofascial tissue was tailored in a chimeric configuration to separately restore the superficial and deep parotid spaces. Results: All flaps survived. One patient developed a postoperative hematoma managed conservatively. Two patients developed minor donor-site seromas after drain removal, which resolved without intervention. Facial contour was satisfactorily restored in all cases, with mild overcorrection in one patient. Facial nerve function improved during follow-up. Donor-site scars were concealed within the infragluteal crease. Conclusions: In this preliminary case series, the AIGP free flap proved to be a feasible option for reconstruction after total parotidectomy with skin and facial nerve preservation, offering satisfactory contour restoration and low donor-site morbidity. Larger studies with longer follow-up are required to define indications and long-term outcomes. Full article

Background/Objectives: Cervical drainage has traditionally been used after thyroidectomy to reduce postoperative fluid accumulation and mitigate bleeding-related complications. However, advances in surgical technique, perioperative hemostasis, and postoperative care pathways have led to an increase in the use of short-stay and outpatient thyroidectomy, prompting renewed evaluation of the role of routine drainage. The objective of this systematic review and meta-analysis was to examine the association between postoperative cervical drainage and postoperative outcomes following thyroidectomy. Methods: A systematic literature search was conducted across PubMed/MEDLINE, Google Scholar, Semantic Scholar, and the Cochrane Central Register of Controlled Trials to identify studies comparing thyroidectomy with versus without cervical drainage. Studies published between January 2005 and January 2026 were eligible for inclusion. Randomized controlled trials and non-randomized comparative studies involving adult patients were included. The outcomes of interest were cervical hematoma, surgical site infection (SSI), seroma formation, postoperative bleeding, reoperation, and length of hospital stay. Random-effects meta-analyses were performed using odds ratios for binary outcomes and mean differences for continuous outcomes. Sensitivity and influence analyses were conducted to assess robustness. The results were additionally examined in prespecified sensitivity analyses restricted to randomized trials, and study-design-stratified estimates are presented. Results: Thirty studies comprising 2810 patients were included. Drain use was not statistically significantly associated with postoperative cervical hematoma (OR 1.28, 95% CI 0.93–1.75; p = 0.124). In contrast, drain use was associated with a significantly increased risk of surgical site infection (OR 2.04, 95% CI 1.46–2.85; p = 0.0002) and a significantly longer postoperative length of hospital stay (mean difference 1.96 days, 95% CI 0.42–3.50; p = 0.016). No statistically significant associations were observed between drainage and seroma formation (OR 0.95, 95% CI 0.70–1.30; p = 0.750), postoperative bleeding (OR 1.26, 95% CI 0.85–1.86; p = 0.228), or reoperation (OR 0.89, 95% CI 0.59–1.32; p = 0.525). Sensitivity and influence analyses demonstrated consistent results across analytical approaches and study designs. Conclusions: In thyroidectomy, routine cervical drainage is not associated with a reduction in bleeding-related complications and is associated with adverse recovery-related outcomes, including increased risk of surgical site infection and prolonged hospitalization. Overall, the findings indicate that routine cervical drainage after thyroidectomy offers no clear advantage in preventing postoperative complications and may be associated with adverse postoperative outcomes. Routine cervical drainage after thyroidectomy was not associated with a protective effect on complications and showed associations with less favorable recovery-related outcomes. Full article

Background: Immediate prepectoral implant-based breast reconstruction (IBR) following skin-reducing mastectomy (SRM) preserves the pectoralis major muscle, improving recovery and aesthetics. A dual-layer technique combining porcine-derived acellular dermal matrix (ADM) with an inferior autologous dermal sling may enhance implant support, vascularization, and lower-pole stability, particularly in patients with macromastia or ptosis. Methods: This retrospective single-center study included 20 patients (24 breasts) who underwent SRM with immediate prepectoral IBR using the dual-layer technique between January 2023 and May 2025. Demographic, oncologic, and perioperative data were collected prospectively. Complications were classified by severity, and patient-reported outcomes were evaluated using the BREAST-Q scale preoperatively and at 1, 3, 6, and 12 months postoperatively. Statistical analysis included paired t-tests, Shapiro–Wilk tests, and effect size estimation (Cohen’s dz). Results: Mean age was 42 ± 6.3 years and BMI 26.1 ± 3.2 kg/m². Mean mastectomy specimen weight was 432.5 ± 120.8 g, and implant volume 375 ± 60 cc. No reconstruction failures or infections occurred. Early complications were reported in 20.8% of breasts, including superficial nipple–areola complex epidermolysis (8.3%), seroma (4.2%), and hematoma (4.2%), all managed conservatively. At 12 months, BREAST-Q scores improved significantly: satisfaction with breasts increased from 63 ± 8 to 89 ± 11 (p < 0.001); psychosocial well-being from 60 ± 10 to 81 ± 11 (p < 0.001); and physical well-being from 62 ± 7 to 82 ± 10 (p < 0.001). Conclusions: Dual-layer prepectoral reconstruction using porcine ADM and autologous dermal sling is safe, provides durable implant stability, and significantly improves patient satisfaction and quality of life following SRM. Full article

Background: Lipomas are common benign subcutaneous neoplasms treated surgically for cosmetic or symptomatic reasons. The minimal one-third incision and four-step (MOTIF) technique provides reliable excision with minimal scarring, but smaller proportional incisions remain unstudied. This study evaluates the minimal one-quarter incision and four-step (MOQIF) technique. Methods: Retrospective review of 82 patients undergoing MOQIF excision of histologically confirmed subcutaneous lipomas by a single surgeon from July 2024–December 2025 was done. Lipomas were stratified by maximum diameter: small-intermediate (<5 cm) and large (≥5 cm). MOQIF used a one-quarter incision of the lipoma’s long axis determined by preoperative ultrasound measurement and palpation with four steps: hydro dissection preserving superficial subcutaneous tissue, superficial dissection, staged deep dissection with selective cautery of fibrovascular septa, and intact mass delivery. Outcomes included excision length, postoperative complications, Vancouver Scar Scale (VSS) scores, recurrence, and subjective treatment satisfaction of patients. Results: Mean lipoma size was 6.8 ± 2.0 cm (75.6% ≥5 cm). All lipomas were completely excised through 1.69 ± 0.49 cm incisions (ratio 0.25). Complications were low: seroma 10.98% (16.7% vs. 9.4%, p = 0.404), hematoma 7.3% (11.1% vs. 6.3%, p = 0.608), with no infections, nerve injuries, or recurrences at a mean 8.9-month follow-up. VSS scores were equivalent between groups (0.83 vs. 1.06; p = 0.438) and overall patient satisfaction was high (3.54 ± 0.53 (2–4)). Conclusions: MOQIF achieves complete lipoma excision through one-quarter incisions with safety and cosmetic outcomes across lipoma sizes, demonstrating feasibility through standardized technique refinement and careful case selection. Full article

Background: Post-bariatric abdominoplasty is associated with a high risk of bleeding and wound complications due to extensive tissue resection and impaired tissue quality. Tranexamic acid (TXA) reduces perioperative bleeding in multiple surgical disciplines, but evidence in massive-weight-loss abdominoplasty is limited. The aim of our study was to evaluate the association between perioperative TXA use and bleeding-related and surgical outcomes in post-bariatric abdominoplasty. Methods: This retrospective cohort study included 97 patients undergoing post-bariatric abdominoplasty, of whom 49 received perioperative TXA and 48 did not. The primary outcome was a composite of bleeding-related complications within 30 days, including hematoma, clinically relevant bleeding, or reoperation. Secondary outcomes included overall and specific surgical site complications, drain output and duration, length of hospital stay, and perioperative hemoglobin changes. Multivariable regression analyses adjusted for body mass index, abdominoplasty type, and year of surgery. Results: Bleeding-related complications were significantly lower in the TXA group compared with controls (4.1% vs. 33.3%; unadjusted OR 0.09, 95% CI 0.02–0.40; p < 0.001). This association remained significant after adjustment (adjusted OR 0.13, 95% CI 0.03–0.68; p = 0.016). TXA use was associated with lower cumulative drain output (median 200 vs. 382.5 mL; p < 0.001) and shorter drainage duration (median 4 vs. 5 days; p < 0.001). Overall complications were reduced in the TXA group (42.9% vs. 66.7%; p = 0.025), driven by fewer wound healing disturbances. Hemoglobin changes, seroma, and infection rates were similar between groups. Conclusions: Perioperative TXA use in post-bariatric abdominoplasty is associated with significantly fewer bleeding-related and wound complications without increased adverse effects, supporting its use in this high-risk population. Full article

Background: Axillary lymph node dissection (ALND) remains necessary for selected patients with breast cancer but is associated with lymphatic morbidity, including seroma formation and breast cancer-related lymphedema (BCRL). The Total Sealing Technique (TST) is a technique-centered operative concept that emphasizes systematic sealing of lymphatic and vascular structures during ALND. Methods: This review integrates mechanistic rationale and clinical evidence derived from comparative cohort studies evaluating TST (using advanced bipolar vessel-sealing systems) versus conventional electrocautery (CONV). Key perioperative and long-term outcomes are summarized quantitatively. Results: In a comparative cohort of total mastectomy with ALND, TST significantly reduced total drainage volume (360.5 ± 187.9 vs. 820.6 ± 661.6 mL; p < 0.001) and shortened time to drain removal (4.8 ± 1.3 vs. 6.8 ± 2.1 days; p < 0.001). Postoperative hospital stay was reduced by 3.7 days on average (5.9 ± 1.3 vs. 9.6 ± 3.4 days; p < 0.001). The incidence of seroma decreased from 65.9% to 28.6% (p = 0.001), with fewer aspiration procedures (1.8 vs. 4.6 per patient; p = 0.022). Importantly, long-term follow-up demonstrated a statistically significant reduction in BCRL incidence (2.9% vs. 22.2%; p = 0.028). Operative time and blood loss were not increased. Conclusions: Current single-center data indicate that TST is associated with substantial reductions in postoperative lymphatic morbidity and a statistically significant decrease in BCRL incidence. While independent multicenter validation is warranted, TST represents a reproducible technique-centered approach with meaningful clinical impact in ALND. Full article

Background/Objectives: Prophylactic mastectomy can significantly reduce the risk of breast cancer in patients carrying gene mutations such as BRCA1 and BRCA2. Patients who opt for breast removal are offered tailored reconstructive options based on their medical history and prior treatments, and in these often young patients with limited autologous tissue reserves, implant-based reconstruction is frequently the option of choice. Complication rates of these procedures are relatively high and account for up to 30%. Subcutaneous mastectomy with primary implant reconstruction carries risks such as hematoma, seroma, skin necrosis, necrosis of the nipple–areola complex, and wound healing issues, which may necessitate revision surgery. This university-center retrospective analysis aims to improve outcomes by identifying patient- and surgery-related risk factors associated with postoperative complications in allogenic breast reconstruction following subcutaneous mastectomy. Methods: We analyzed 61 female patients and 122 breasts who underwent primary implant-based reconstruction after skin- or nipple-sparing subcutaneous mastectomy over three years between January 2021 and December 2023. Demographic and surgical variables were systematically collected and analyzed. Results: The mean patient age was 41.5 ± 10.3 years. A total of 13% of patients were active smokers, and 1.6% had diabetes mellitus. Overall, skin flap necrosis occurred in 27.9% of patients (22.1% of breasts), wound healing disorders in 19.7% of patients, wound infections in 9.8%, and revision surgery in 18.0%. A history of pregnancy was associated with skin flap necrosis (OR 10.07, 95% CI 1.79–190.06; p = 0.032); however, this finding must be interpreted with caution due to limited statistical power and model instability. Conclusions: This investigation revealed clinically relevant patterns suggesting potential risk factors for wound healing disorders and skin necrosis. Prospective studies are planned to further substantiate these findings and to help reduce overall complication rates associated with the procedure. Full article

Background/Objectives: Trochanteric pressure ulcers represent a challenging reconstructive problem due to their depth, frequent infection, and tendency for recurrence. Durable coverage with well-vascularized tissue capable of effective dead-space management is essential for long-term stability. The pedicled musculocutaneous anterolateral thigh (ALT) flap offers substantial soft-tissue volume with reliable regional vascularity. Methods: A retrospective review was performed of consecutive patients with Stage IV trochanteric pressure ulcers who underwent reconstruction using musculocutaneous pedicled island ALT flaps between January 2020 and August 2023. Ulcers were classified according to the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance International Guidelines. Patients with a minimum follow-up of 24 months were included. Demographic characteristics, ulcer etiology, prior flap history, comorbidities, flap dimensions, postoperative complications, and recurrence rates were analyzed. Results: Eight patients (4 males, 4 females; mean age 46.4 years, range 35–63) were included. Six ulcers (75%) were related to prolonged immobilization, and two (25%) developed following entrapment during the 2023 Kahramanmaraş earthquake. All donor sites were closed primarily. Minor recipient-site complications, including seroma and limited suture dehiscence, occurred in two cases. No partial or total flap necrosis was observed. During a mean follow-up of 42.4 months (minimum 24 months), no recurrence occurred. Conclusions: Musculocutaneous pedicled ALT flaps incorporating a substantial portion of the vastus lateralis muscle allowed effective dead-space obliteration and durable soft-tissue coverage in Stage IV trochanteric pressure ulcers. Primary donor-site closure was achievable without major morbidity. These findings support the use of the pedicled ALT flap as a consistent regional option in complex trochanteric defects, including both chronic immobilization-related and acute compression-related cases. Full article

Introduction: Implant-based breast reconstruction is associated with an increased risk of ischemic complications, which may result in implant loss, suboptimal aesthetic outcomes, and delays in adjuvant oncological treatment. Additionally, axillary surgery carries a risk of upper-limb lymphedema. Indocyanine green (ICG) angiography enables more accurate real-time assessment of tissue perfusion than clinical evaluation alone, while axillary reverse mapping (ARM) facilitates the preservation of upper-limb lymphatics. The integration of these techniques reduces complications and improves both functional and aesthetic outcomes. Materials and methods: A total of 208 breast cancer patients who underwent mastectomy followed by immediate implant-based breast reconstruction were enrolled in this case–control study. The prospective intervention group received intraoperative ICG angiography at three time points and underwent ARM with ICG. Conventional surgical techniques were applied in the retrospective control group. Results: ICG angiography showed excellent diagnostic accuracy for predicting postoperative ischemic complications (AUC = 0.93, 95% CI 0.82–0.99, p < 0.001). Compared with the control group, patients in the ICG group had significantly lower rates of mastectomy skin flap necrosis (11.5% vs. 30.8%, p = 0.001), seroma (4.8% vs. 14.4%, p = 0.032), hematoma (1.9% vs. 9.6%, p = 0.033), and lymphedema (2.9% vs. 17.3%, p < 0.001). They also experienced shorter hospitalization (6.2 ± 1.9 vs. 8.0 ± 2.8 days, p < 0.001), fewer delays in adjuvant treatment initiation (16.3% vs. 32.7%, p = 0.010), and higher aesthetic satisfaction scores (81.41 ± 10.12 vs. 76.03 ± 9.74, p <0.001). Conclusions: Intraoperative indocyanine green angiography is a valuable tool for predicting ischemic complications in alloplastic breast reconstruction and is associated with reduced morbidity, fewer delays in adjuvant treatment, and improved aesthetic outcomes. Preliminary evidence suggests that axillary reverse mapping is associated with lower rates of upper-limb lymphedema. Full article

Background/Objectives: Over the last decade, the role and timing of lymph node dissection (LND) in stage III melanoma has shifted from completion LND after a positive sentinel node to a mainly therapeutic procedure for clinically evident nodal disease, driven by randomized evidence showing no survival benefit for routine completion dissection. In this evolving landscape, real-world data on postoperative morbidity—by nodal basin—and on whether complications may influence melanoma-specific survival (MSS) and disease-free survival (DFS) remain limited. We evaluated 90-day postoperative complications after cervical, axillary, and inguino–iliac–obturator LND and explored their association with survival outcomes and treatment era. Methods: We retrospectively analyzed 185 consecutive stage III melanoma patients undergoing LND at a single tertiary center (January 2004–August 2025). Postoperative morbidity was recorded up to 90 days and graded by Clavien–Dindo; given the very low rate of grade > II events, the primary endpoint was a composite of loco-regional surgical field–related complications (persistent seroma, wound dehiscence, surgical-site infection, limb lymphedema). Risk factors were assessed using logistic regression; Firth’s penalized models were applied when appropriate. MSS and DFS were estimated by Kaplan–Meier and explored with Cox models. Results: Median follow-up was 105 months. Surgical field–related complications occurred in 16.8% (31/185), and postoperative mortality was 1.0% (2/185). In multivariable analyses, inguino–iliac–obturator LND was associated with higher odds of overall complications (OR 4.03) and specifically wound dehiscence (OR 4.79) and infection (OR 7.18) versus axillary LND. MSS (n = 179) was 82% at 1 year, 55% at 5 years, and 49% at 10 years; DFS (n = 171) was 63%, 42%, and 41%, respectively. In era-based comparisons, nodal yield decreased in the post–MSLT-II period without clear separation of MSS/DFS curves; exploratory models did not show a consistent independent signal linking postoperative complications to MSS/DFS. Conclusions: In stage III melanoma, LND was associated with low major morbidity, but clinically meaningful locoregional complications persisted—most notably after inguino–iliac–obturator dissection. These data support careful patient selection and basin-tailored strategies to reduce groin morbidity within modern multidisciplinary management. Full article

The objectives of this work were (i) to evaluate the incidence of complications in male horses after orchiectomy performed in the field, i.e., away from a veterinary hospital, (ii) to describe the post-operative complications that occurred in these animals and (iii) to study the potential predictors for the development of such complications. This study involved 612 animals, on which orchiectomy was performed. The operative part of the study was carried out by one of three experienced veterinary surgeons. Standard pre-operative procedures were followed. Orchiectomy was performed using one of three principal surgical techniques, open, semi-closed or closed, and hemostasis was achieved by means of one of the various procedures, specifically the use of the Henderson instrument, the use of the Reimer emasculator, the ligation of the testicular artery or combinations thereof. In cases of reported complications, these were verified and identified appropriately. At least one (any) post-operative complication was recorded in 145 horses (23.7%). The most frequently observed complication was scrotal swelling/seroma formation, which was observed in 130 animals (21.2% of all animals; 89.7% of animals with at least one (any) complication). Another six different complications were observed, specifically colic, continued stallion-like behavior, evisceration, funiculitis, hemorrhage and scrotal infection. The median age of horses with complications was significantly older than that of animals with no complications: 11 versus 9 years. Animals in which the open technique was applied developed post-operative complications more frequently (30.1% of animals thus operated); further, complications were observed more frequently in animals on which operations were performed by using the Henderson instrument (84.6% of animals) versus animals on which any of the various other procedures were applied (22.4%). In multivariable analysis, the following predictors emerged for the development of complications: the surgical technique employed, the procedure applied for hemostasis, older animal age, and heavier animal bodyweight. The findings confirm that orchiectomy in stallions, even when performed in field conditions, is, in general, a safe procedure. The identification of predictors suggests that veterinarians should take additional care when planning to operate on animals at higher risk or when using surgical approaches that increase the potential for the development of complications. Full article