Comparison of the Recurrence Rate of Gastric Dilatation with or Without Volvulus in Dogs after Circumcostal Gastropexy Versus Gastrocolopexy

OBJECTIVE: To compare the recurrence rate of acute gastric dilatation with or without volvulus (GDV) after circumcostal gastropexy (CCGP) or gastrocolopexy (GCP) in dogs. STUDY DESIGN: A prospective, double-blind, multicenter, randomized, controlled, clinical trial with two groups (A and B). ANIMALS: Fifty-four client-owned dogs presented for treatment of GDV. METHODS: Dogs with acute GDV that had not previously had a gastropexy performed were included. The preoperative treatment before gastropexy was standardized. A CCGP was performed on dogs in group A, and a GCP was performed on dogs in group B. Postoperative treatment was standardized, but deviation did occur according to the special needs of particular patients. A minimal follow-up time of 180 days was required for dogs not excluded from the study. The median follow-up time in group A was 700 days; in group B, it was 400 days. The occurrence of abdominal pain and gastrointestinal problems after surgery were recorded by the owners. RESULTS: There was no significant difference in the recurrence rate of GDV between the two groups. At the end of the study, the recurrence rate was 9% and 20% in group A and in group B, respectively. CONCLUSIONS: Both surgical techniques are effective in preventing recurrence of GDV.     

Prospective Evaluation of Two Intracorporeally Sutured Prophylactic Laparoscopic Gastropexy Techniques Compared with Laparoscopic-Assisted Gastropexy in Dogs

Objective— To report technique, surgical time, complication rate, and postoperative activity in dogs undergoing 2 intracorporeally-sutured total laparoscopic gastropexy (TLG) techniques compared with a laparoscopic-assisted gastropexy (LAG) technique.
Study Design— Randomized clinical trial.
Animals— Dogs (n=30) weighing >25 kg.
Methods— Dogs were randomly assigned to 1 of 3 groups. Two TLG techniques were performed using a median 3 portal technique. One of 2 suturing techniques was used to approximate corresponding incisions made in the stomach and body wall; using intracorporeal hand-suturing or a suture-assist device (Endostitch^™). In a 3rd group, a previously reported LAG technique was used. All dogs had an activity monitor placed for 7 days pre- and postoperatively. Linear regression analyses were performed to evaluate the association of surgical procedure on gastropexy time and the percentage change in activity counts.
Results— Median gastropexy time was 28 minutes (range, 20–41 minutes) for LAG, 48 minutes (range, 39–61 minutes) for the hand suture TLG technique, and 56 minutes (range, 30–90 minutes) for the Endostitch^™ TLG technique. LAG was performed faster than TLG ( P <.05). LAG dogs had a greater decrease in postoperative activity than TLG dogs ( P =.005); however there was no difference in surgical time or postoperative activity between TLG techniques.
Conclusions— TLG can be performed safely and effectively in dogs and although it takes longer, it has less impact on postoperative activity compared with LAG.
Clinical Relevance— TLG techniques may have advantages over LAG as measured by a greater willingness of dogs to move around postoperatively.     

Evaluation of Percutaneous Gastrostomy as a Technique for Permanent Gastropexy

Objective- This study was designed to evaluate right-sided percutaneous endoscopic gastrostomy (PEG) as a method for creation of a permanent gastropexy.
Study Design- Percutaneous endoscopic gastrostomy adhesions were evaluated by gross examination and by mechanical testing and the results were compared with those obtained by conventional incisional gastropexy.
Animals or Sample Population- Fourteen mixed-breed dogs.
Methods- Incisional gastropexies were performed on the dogs of group one (N = 7) and PEG tubes were placed in the dogs of group 2 (N = 7). All skin sutures (group 1) and PEG tubes (group 2) were removed on day 14. The animals were maintained for an additional 44 days before euthanasia and immediate necropsy. Gastropexy adhesions were evaluated and collected for biomechanical evaluation using a materials testing machine.
Results- The duration of the procedure for group 2 was less (32.86 min ±7.65) than for group 1 (56.29 min ±8.28). The number of complications was not significantly different between group 1 and group 2 ( P =.103). Gastroperitoneal adhesions were present in 7 of 7 dogs in group 1 and 4 of 7 dogs in group 2. The adhesion lengths and widths were significantly larger in dogs in group 1 compared with those in group 2. The adhesions present in group 1 dogs sustained significantly greater tensile loads to failure (61.98 ±14.65 N), compared with the adhesions present in group 2 dogs (22.31 ±26.87 N).
Conclusions- Right-sided PEG inconsistently formed a weak gastropexy and the procedure was associated with a trend toward greater morbidity than incisional gastropexy.
Clinical Relevance- Right-sided PEG is not recommended as a means of prophylactic gastropexy.     

Biomechanical and Histological Evaluation of a Laparoscopic Stapled Gastropexy Technique in Dogs

The biomechanical holding strength and histological characteristics of a laparoscopic stapled gastropexy (LG) adhesion were compared with that of an incisional gastropexy (IG) adhesion. An LG was performed in 14 dogs and an IG was performed in six dogs. During the LG procedure, the abdomen was insufflated with carbon dioxide and three cannulae were placed in the caudal aspect of the right side of the abdomen. A 35 mm laparoscopic stapler was used to staple the gastric antrum to the adjacent right lateral abdominal wall. The IG procedure was performed through a ventral midline celiotomy. A 35 mm IG was made by apposing the gastric antrum to the adjacent right lateral abdominal wall with two continuous rows of suture. Half of each group of dogs was euthanatized at 7 and 30 days after surgery. The mean tensile load to failure at 7 days was 44.86 ± 18.54 N for the LG group and 85.33 ± 23.59 N for the IG group ( P <.05). At 30 days the values were 72.93 ± 18.01 N for the LG group and 71.17 ± 12.11 N for the IG group ( P =.41). The gastropexy adhesions in the 7-day postoperative group contained variable amounts of fibrin, hemorrhage, mononuclear cell inflammation, loose fibrovascular tissue, and mature collagenous connective tissue. Adhesions in the 7-day postoperative group were divided subjectively into three histological subgroups based on the relative amounts of mature connective tissue within the adhesion. The LG and IG adhesions were randomly distributed among these subgroups ( P = 1.0). Adhesions in the 30-day postoperative group contained well-organized fibrous connective tissue. No difference in the amount of connective tissue could be detected histologically in the LG or IG adhesions. Complications with the LG procedure included stomach perforation (2 cases), splenic puncture (2 cases), and subcutaneous emphysema (4 cases).     

Presumptive Intramural Gastric Hemorrhage Secondary to Rodenticide Intoxication in a Dog

A dog being treated for demodicosis with ivermectin was presented for intermittent vomiting. The vomiting progressed to hematemesis and an underlying coagulopathy was diagnosed. The etiology of the coagulopathy was determined to be ingested brodifacoum. Ultrasound evaluation of the abdomen revealed thickened gastric wall that was suspected to be intramural hemorrhage. Most likely, the intramural hemorrhage and resulting thickening of the stomach wall led to the clinical signs and metabolic alkalosis. This case represents an typical presentation of hemorrhage secondary to rodenticide intoxication. (J Vet Emerg Crit Care 2001; 11(1):27–31, 2001).     

Gastric dilatation-volvulus in dogs

Gastric dilatation-volvulus (GDV) is a disease in which there is gross distension of the stomach with fluid or gas and gastric malpositioning. It causes pathology of multiple organ systems and is rapidly fatal. It is common in large- and giant-breed dogs. The disease appears to have a familial predisposition. Thoracic depth/width ratio also appears to predispose dogs to GDV. Implicated dietary factors include dietary particle size, frequency of feeding, speed of eating, aerophagia and an elevated feed bowl. A fearful temperament and stressful events may also predispose dogs to GDV. Abdominal distension, non-productive retching, restlessness, signs of shock, tachypnoea and dyspnoea are possible clinical signs. Initial treatment includes treatment of shock and gastric decompression. Surgical treatment should be performed promptly. There are no studies comparing the use of different anaesthetic agents in the anaesthetic management of GDV. Pre-medication with an opioid/benzodiazepine combination has been recommended. Induction agents that cause minimal cardiovascular changes such as opioids, neuroactive steroidal agents and etomidate are recommended. Anaesthesia should be maintained with an inhalational agent. Surgical therapy involves decompression, correction of gastric malpositioning, debridement of necrotic tissue, and gastropexy. Options for gastropexy include incisional, tube, circumcostal, belt-loop, incorporating, and laparoscopic gastropexy. Expected mortality with surgical therapy is 15–24%. Prognostic factors include mental status on presentation, presence of gastric necrosis, presence of cardiac arrhythmia and plasma lactate levels. Prophylactic gastropexy should be considered in dogs identified as being at high risk.     

Pneumatosis in Canine Gastric Dilatation-Volvulus Syndrome

Retrospectively, 243 dogs with radiographic evidence of gastric dilatation-volvulus (GDV) were studied for radiographic signs of pneumatosis (intramural gas), pneumoperitoneum, splenomegaly, and severity of gastric distention. The sensitivity, specificity, and predictive value of these imaging signs as predictors of gastric wall necrosis, as determined by visual inspection at surgery or necropsy, were determined. The sensitivity and specificity of gastric pneumatosis were 14.1% and 92.7%, respectively. The prevalence of gastric wall necrosis was 26.6%. The positive and negative predictive values of gastric pneumatosis for predicting gastric necrosis were 40.9% and 74.9%, respectively. Gastric pneumatosis and pneumoperitoneum were identified together in four dogs. Pneumoperitoneum, either alone or in conjunction with pneumatosis, yielded similar results as a test for gastric necrosis. Splenomegaly and severity of gastric distention were insensitive and nonspecific for gastric wall necrosis. Splenomegaly did not predict the need for splenectomy at surgery. Although pneumatosis and pneumoperitoneum are relatively specific signs of gastric wall necrosis, the utility of these signs as a test for gastric necrosis is limited in clinical practice. The significance of pneumatosis should be taken into consideration with previous treatments for gastric decompression, as percutaneous gastric trocharization or orogastric intubation may increase the number of false-positive results.     

Biomechanical Evaluation of Gastropexy Techniques in the Dog

The relative strength of adhesions created by three different gastropexy techniques in dogs was evaluated two and six months following surgery. Tube gastrostomy formed a stronger adhesion (p>.001) when compared with simple gastropexy and permanent gastropexy two months after operation. In a smaller number of animals examined at six months, no difference in strength was noted between permanent gastropexy and tube gastrostomy.