Gastric Drainage Procedures: Effects in Normal Dogs II. Clinical Observations and Gastric Emptying

Complete gastric emptying time using barium sulfate mixed with commercial canned dog food was measured radiographically in 29 mature mixed breed dogs before and 3 to 4 weeks after Fredet-Ramstedt pyloromyotomy (FRP) (6 dogs), Heineke-Mikulicz pyloroplasty (HMP) (6 dogs), Finney pyloroplasty (FP) (6 dogs), Jaboulay's gastroduodenostomy (JG) (6 dogs), and antral gastrojejunostomy (AG) (5 dogs). The dogs were observed for clinical evidence of side effects. Postoperative endoscopic examination and double contrast gastrography were performed to subjectively evaluate the diameter of the gastrointestinal communication and the amount of enterogastric reflux. Although none of the procedures significantly (p < 0.05) altered gastric emptying time, the overall tendency was toward slowing down gastric emptying time. The severity of gastrointestinal side effects and enterogastric reflux appeared to be related to the size and/or location of the gastrointestinal opening.     

Gastric Drainage Procedures: Effects in Normal Dogs I. Introduction and Description of Surgical Procedures

Gastric drainage procedures are commonly used in veterinary medicine, particularly in dogs in attempts to prevent recurrence of gastric dilatation-volvulus (GDV). The following five different procedures have been most commonly described: the Fredet-Ramstedt pyloromyotomy (FRP); Heineke-Mikulicz pyloroplasty (HMP); Finney pyloroplasty (FP); Jaboulay's gastroduodenostomy (JG); and antral gastrojejunostomy (AG). These surgical procedures have not been compared in a controlled study. This first article of a series of three describes the gastric drainage procedures performed in 30 normal dogs for a comparative study. The FRP and HMP were the fastest and easiest procedures to perform. The degree of difficulty was found to be increased but similar for FP, JG, and AG. No complication occurred during or immediately after surgery.     

Effects of the Y-U Pyloroplasty on Gastric Emptying and Duodenogastric Reflux in the Dog

A Y-U pyloroplasty was performed on five healthy adult dogs. Gastric emptying half times (t1/2 GE) of a canned food meal were measured by scintigraphy three times before surgery and three times from 6 to 8 weeks after surgery. Fluoroscopic studies of gastric and duodenal motility were made before surgery and 3, 7, and 35 days after surgery. Clinical observations were made daily throughout the study. Gross and histologic evaluations of the gastroesophageal and pyloric regions were performed at the termination of the study. The t1/2 GE was significantly decreased after surgery. By positive contrast fluoroscopy, the vigor of antral contractions was seen to be decreased in three of the five dogs. On days 7 and 35, fluoroscopic findings were comparable to preoperative studies. Duodenogastric reflux was recognized fluoroscopically in three dogs on four different occasions. This may reflect normal reflux patterns in the dog. No gastrointestinal problems were evident after surgery in four dogs. Reflux esophagitis developed in one dog after surgery, which resolved with therapy. Studies of the Y-U pyloroplasty after 2 months indicated that it decreased gastric emptying time of solid food. Results of postmortem examination showed no abnormal gross or histopathologic changes of esophageal, gastric, or proximal duodenal tissues.     

Significance of the Heineke-Mikulicz Pyloroplasty in the Treatment of Gastric Dilatation-Volvulus A Prospective Clinical Study

Twenty-six dogs with gastric dilatation-volvulus (GDV) were stabilized medically, followed by tube gastrostomy and gastropexy. In 13 dogs, a Heineke-Mikulicz pyloroplasty was also performed. Complications and recurrences were monitored during the immediate postoperative period and for 5 to 31 months thereafter. Barium gastrograms and contrast radiographs of the stomach were evaluated at week 1 and months 5 to 31. Significantly fewer dogs without pyloroplasty had complications during the immediate postoperative period. There were no differences in the long-term complication rates. Radiographic evaluations of the width of the pylorus, the size of the stomach, and the rate of gastric emptying showed no differences between dogs with and without pyloroplasty at any evaluation period. The Heineke-Mikulicz pyloroplasty increased the immediate postoperative complication rate after surgical fixation of the stomach for the treatment of GDV. It did not appear to influence the long-term outcome of the surgical treatment of this disease. The Heineke-Mikulicz pyloroplasty is not recommended in the treatment of GDV unless pyloric outflow obstruction can be demonstrated.     

Gastric Drainage Procedures: Effects in Normal Dogs III. Postmortem Evaluation

Postmortem macroscopic examination of the gastrointestinal tract and plastic moldings of the gastrointestinal communication were done in 29 dogs which had been subjected 3 to 4 weeks previously to one of the following gastric drainage procedure: (1) Fredet-Ramstedt pyloromyotomy (FRP) (6 dogs); (2) Heineke-Mikulicz pyloroplasty (HMP) (6 dogs); (3) Finney pyloroplasty (FP) (6 dogs); (4) Jaboulay's gastroduodenostomy (JG) (6 dogs); and (5) antral gastrojejunostomy (AG) (5 dogs). Plastic moldings were also done in nine normal dogs of similar size for comparative measurements. Postmortem examinations and plastic casts of the antropyloroduodenal segment and antrojejunal communication showed significantly widened pyloric canal or large gastrointestinal communication compared to control dogs in all groups except for the FRP group. Almost complete healing had occurred at the myotomy site in FRP dogs, and the pyloric lumen was not significantly larger (less than 0.05) than the pyloric lumen of the control dogs. The lumen of the gastrointestinal junction was increased approximately 4.5 times in the HMP group, 12.0 times in the FP group, 7.2 times in the JG group, and 10.0 times in the AG group.     

Comparison of ultrasonographic characteristics of the gastroduodenal junction during pyloroplasty performed laparoscopically or via conventional abdominal surgery in dogs

OBJECTIVE: To evaluate the use of ultrasonography to detect morphologic changes in the pylorus during pyloroplasty performed laparoscopically or via conventional abdominal surgery in dogs. ANIMALS: 10 healthy mixed-breed dogs. PROCEDURE: Laparoscopic ultrasonography of the pylorus was performed in 5 dogs during laparoscopic pyloroplasty (LP), and ultrasonography of the pylorus was performed in 5 dogs during pyloroplasty via conventional abdominal surgery (CAP group). Appearance and dimensions of the pyloric sphincter were evaluated by use of a 7.5-MHz flexible laparoscopic linear-transducer probe. RESULTS: Mean +/- SD duration of the ultrasonographic procedure was 11 +/- 3.04 minutes (range, 6 to 18 minutes). In the CAP group, cross-sectional views of the pylorus revealed significant differences between the overall transverse external diameter, overall craniocaudal external diameter, and transverse diameter of the pyloric lumen. After surgery, the pyloric area was significantly increased. Longitudinal views of the pylorus revealed that width of the pyloric ring was significantly less after surgery. Transverse views of the pylorus for the LP group revealed a significant increase in the transverse diameter and craniocaudal diameter of the pyloric lumen after LP. The pyloric area was also significantly increased after surgery. Longitudinal views of the pylorus revealed that width of the pyloric ring was significantly less after surgery. Transverse diameter of the pyloric lumen was significantly increased after LP. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of results of this study suggests that ultrasonography is useful for detecting relevant morphologic changes in the pyloric sphincter after pyloroplasty.     

Gastric emptying of a radionuclide-labeled test meal after surgical correction of gastric dilatation-volvulus in dogs

Gastric emptying of a radionuclide-labeled test meal was studied in 10 dogs that had been treated surgically for gastric dilatation-volvulus and in 10 clinically normal (control) dogs. There were no significant differences between the gastric emptying rates and patterns in treated and in control dogs. Thus, there are no indications that gastric emptying is delayed in dogs that have recovered from gastric dilatation-volvulus, and there is no reason for pyloric surgery in dogs with this condition.     

A rapid and strong laparoscopic-assisted gastropexy in dogs

OBJECTIVE: To develop a technique for laparoscopic gastropexy in dogs and evaluate effects on stomach position and strength of the adhesion between the stomach and abdominal wall. ANIMALS: 8 healthy dogs. PROCEDURE: Dogs were anesthetized, and the abdomen was insufflated with carbon dioxide. A laparoscope was placed through a cannula inserted on the abdominal midline caudal to the umbilicus. Babcock forceps placed through a cannula inserted lateral to the right margin of the rectus abdominus muscle were used to exteriorize the pyloric antrum, a longitudinal incision was made through the serosa and muscular layer of the pyloric antrum, and the seromuscular layer of the pyloric antrum was sutured to the transversus abdominus muscle. After surgery, positive-contrast gastrography was used to evaluate stomach position and the onset of gastric emptying, and ultrasonography was used to assess stomach wall activity and mobility. Dogs were euthanatized 1 month after surgery, and tensile strength of the adhesion was tested. RESULTS: In all dogs, stomach position and the onset of gastric emptying were normal 25 days after surgery, and the pyloric antrum was firmly attached to the abdominal wall 30 days after surgery. Mean +/- SD ultimate load of the adhesion in tension was 106.5 +/- 45.6 N. CONCLUSIONS AND CLINICAL RELEVANCE: The laparoscopic gastropexy technique described in the present study could be performed quickly and easily by an experienced surgeon, resulted in a strong fibrous adhesion between the stomach and abdominal wall, and appeared to cause minimal stress to the dogs.     

Chronic hypertrophic pyloric gastropathy in 14 dogs

SUMMARY Ten mate and 4 female dogs with chronic hypertrophic pyloric gastropathy were seen at the Sydney University Veterinary Teaching Hospital in the period 1982–88. The most commonly affected breeds were the Shihtzu and Maltese. The mean age was 8.2 yr and the mean body weight 6.5 kg. The most common clinical signs were vomiting, weight loss, polydipsia and depression. Hypokalaemia was present in 11 of 12 dogs examined and hypochloraemia in 10 of 11 dogs examined. Five of the six dogs that had blood gases measured were found to have a metabolic alkalosis. Surgery was performed on 13 dogs; pyloromyotomy 7, pyloroplasty 4, gastroduodenostomy 2. There was a recurrence of symptoms in one pyloromyotomy dog, and fatal ulceration and perforation of the cardia occurred in one pyloroplasty case. The remaining 11 dogs had a mean known symptom-free survival time of 20 mo. This study confirms the preponderance of affected males, identifies electrolyte and blood gas disturbances as significant complications of chronic hypertrophic pyloric gastropathy, and suggests that relatively minor surgery (pyloromyotomy) may have a place in the treatment of a selected subgroup of cases.     

Perforated gastric ulcer v associated with pyloroplasty for chronic hypertrophic pyloric gastropathy in a dog

A six-year-old male silkie terrier presented with a history of chronic vomiting. A diagnosis of gastric outflow obstruction was made using contrast radiography of the upper gastrointestinal tract. Surgical examination of the stomach revealed thickened pyloric antral mucosa. A Heineke-Mikulicz pyloroplasty combined with resection of the hypertrophic pyloric mucosa were performed to increase the patency of the pyloric lumen. The dog recovered well from surgery and his condition remained stable until the sixth day postoperatively when his condition deteriorated rapidly resulting in his death that night. At autopsy a perforated gastric ulcer was found in the cardiac region of the pylorus with evidence for a generalised peritonitis. An association between gastric outflow obstruction and gastric ulceration has been reported in human clinical literature and in canine experimental models. No such association has been previously documented in the veterinary clinical literature.     

Pathogenetic and Therapeutic Aspects of Torsion of the Canine Stomach

In dogs that had survived attacks of gastric torsion, X-ray examination after subsidence of the acute symptoms usually disclosed retarded emptying of the stomach with normal or, in some cases, hyperactive motility, apparently due to pyloric sphincter dysfunction. On the basis of these findings it is hypothesized that torsion should be regarded as the final stage of a chronic dilatation of the stomach stemming from the deranged emptying mechanism. Intensive nonsurgical management of the acute phase, with evacuation of the stomach via trocarization and repeated introduction of a stout gastric tube, appears superior to primary surgical treatment insofar as the early results are concerned. The abovementioned roentgenologic observation has led the authors to try, in the hope of preventing recurrences, operative correction of the disordered emptying mechanism by means of gastrojejunostomy or pyloroplasty. As yet the series is too small and the follow-up times too short for therapeutic evaluation of these surgical procedures.     

SCINTIGRAPHIC EVALUATION OF SOLID-PHASE GASTRIC EMPTYING IN THE DOG

A technique for scintigraphically quantitating solid-phase gastric emptying in the dog was developed in a Beagle model. The test meal was determined to empty in a linear fashion, indicating a solid-phase label. The evaluation was performed on a group of dogs presented for gastrointestinal signs that were judged to have normal liquid barium sulfate fluoroscopic and radiographic studies. The results of this study indicate that this technique is valuable for identifying those patients with surgically correctable pyloric obstruction that exhibit normal gastric emptying of liquid barium.     

Paraesophageal hiatal hernia and pyloric obstruction in a dog

Paraesophageal hiatal herniation and pyloric obstruction were diagnosed in a pup with a history of vomiting. Findings of contrast radiography included esophageal reflux, delayed gastric emptying time, and paraesophageal herniation. Exploratory celiotomy revealed increased firmness of the pylorus and a primary defect in the esophageal hiatus, which allowed gastric herniation. Nissen fundoplication was performed following reconstruction of the esophageal hiatus, and pyloroplasty was performed to relieve the gastric outlet obstruction. Pyloric biopsy findings were consistent with a diagnosis of chronic gastritis. Recovery from surgery was initially unremarkable; however, the dog died suddenly 3 weeks after surgery. Necropsy revealed a large diaphragmatic hernia adjacent to the esophageal hiatus; the hernia had resulted in incarceration of the abdominal organs. The hiatal hernia reconstruction remained intact and was not the cause of the diaphragmatic disruption.     

A Laparoscopic‐Sutured Gastropexy Technique In Dogs: Mechanical and Functional Evaluation

Objective— To describe a laparoscopic‐sutured gastropexy technique in dogs and evaluate the tensile strength of the adhesion and effects on gastric function. Study Design— Experimental study. Animals— Female beagle dogs (n=7). Methods— A laparoscopic‐sutured gastropexy technique was evaluated by ex vivo tensile distraction tests 10 weeks after surgery. The effect of the adhesion on gastric emptying, mucosal permeability, and systemic inflammation were evaluated by monitoring the C‐reactive protein (CRP) and sucrose permeability, and by radiographic evaluation of gastric emptying 2 weeks before and 10 weeks after surgery. Results— Mean (±SD) tensile force to disrupt adhesions was 51.1±16.4 N. There was no significant postoperative increase in CRP concentration or change in sucrose permeability. The area under the curve representing the postprandial decrease in gastric radiographic area increased by 11% after gastropexy. Conclusions— This laparoscopic gastropexy technique had appropriate mechanical and functional characteristics with limited morbidity. Clinical Relevance— This laparoscopic‐sutured gastropexy provides adhesion strength comparable with other gastropexy techniques tested at 10 weeks postoperatively. Only minor changes in gastric emptying were observed 10 weeks after surgery.     

Gastric emptying of nondigestible radiopaque markers after circumcostal gastropexy in clinically normal dogs and dogs with gastric dilatation-volvulus.

Using radiopaque particles mixed with food, gastric emptying was assessed in healthy dogs not subjected to surgery, in healthy dogs 9 to 35 days after circumcostal gastropexy, and, in dogs 1 to 54 months after surgical treatment and recovery from gastric dilatation-volvulus (GDV). Circumcostal gastropexy surgery did not alter the 90% gastric emptying time for radiopaque particles in healthy dogs. However, 90% gastric emptying time was significantly (P less than 0.05) increased after circumcostal gastropexy in dogs with GDV, compared with healthy dogs after the same surgical procedure and recovery period. These results imply that dogs with GDV have delayed gastric emptying of solid particles. Whether delayed gastric emptying of markers detected in affected dogs after surgical treatment and recovery was the result or the cause of GDV was not determined. Results indicate that circumcostal gastropexy could be recommended as a prophylactic procedure for GDV in large breeds with deep thorax, because delayed gastric emptying of markers secondary to the surgical procedure is unlikely.     

A review of methods for assessment of the rate of gastric emptying in the dog and cat: 1898-2002

Gastric emptying is the process by which food is delivered to the small intestine at a rate and in a form that optimizes intestinal absorption of nutrients. The rate of gastric emptying is subject to alteration by physiological, pharmacological, and pathological conditions. Gastric emptying of solids is of greater clinical significance because disordered gastric emptying rarely is detectable in the liquid phase. Imaging techniques have the disadvantage of requiring restraint of the animal and access to expensive equipment. Radiographic methods require administration of test meals that are not similar to food. Scintigraphy is the gold standard method for assessment of gastric emptying but requires administration of a radioisotope. Magnetic resonance imaging has not yet been applied for assessment of gastric emptying in small animals. Ultrasonography is a potentially useful, but subjective, method for assessment of gastric emptying in dogs. Gastric tracer methods require insertion of gastric or intestinal cannulae and are rarely applied outside of the research laboratory. The paracetamol absorption test has been applied for assessment of liquid phase gastric emptying in the dog, but requires IV cannulation. The gastric emptying breath test is a noninvasive method for assessment of gastric emptying that has been applied in dogs and cats. This method can be carried out away from the veterinary hospital, but the effects of physiological and pathological abnormalities on the test are not known. Advances in technology will facilitate the development of reliable methods for assessment of gastric emptying in small animals.     

Use of the 13C-octanoic acid breath test for assessment of solid-phase gastric emptying in dogs.

OBJECTIVE: To assess the 13C-octanoic acid breath test for determining gastric emptying in dogs. ANIMALS: 6 healthy adult dogs. PROCEDURE: Food was withheld for 12 hours before each test. Expired air was collected 30 minutes and immediately before each test and at frequent intervals thereafter for 6 hours. Concentration of 13CO2 in expired air was determined by use of continuous-flow isotope-ratio mass spectrometry. Basal concentration of 13CO2 was measured in dogs that were not fed a test meal. Effects of the standard unlabeled test meal on basal concentration of 13CO2 were then assessed. The optimum dose of substrate was determined by measuring 13CO2 concentration after ingestion of the standard test meal containing 50 or 100 mg of 13C-octanoic acid, whereas effect of energy density of the test meal on gastric emptying was determined after ingestion of the standard or high-energy labeled test meal. Gastric emptying coefficient (GEC), time to peak 13CO2 concentration (tmax), and half-dose recovery time (t(1/2)) were calculated. RESULTS: Basal concentration of 13CO2 in expired air was not significantly affected by ingestion of the unlabeled test meal. However, 13CO2 concentration significantly increased in a dose-dependent manner after ingestion of the labeled meal. Gastric emptying coefficient, and were significantly different between dogs fed the standard and high-energy test meals, indicating that ingestion of a high-energy meal delays gastric emptying. CONCLUSIONS AND CLINICAL RELEVANCE: The 13C-octanoic acid breath test may be a useful noninvasive and nonradioactive method for assessment of gastric emptying in dogs.     

Effect of prolonged general anesthesia with sevoflurane and laparoscopic surgery on gastric and small bowel propulsive motility and pH in dogs

ObjectiveTo determine if general anesthesia with sevoflurane and laparoscopic surgery changed gastric and small bowel propulsive motility or pH in dogs.Study designProspective, controlled trial.AnimalsTwelve, 19–24 months old, female, Treeing Walker Hound dogs, weighing 23–30 kg.MethodsDogs were anesthetized for a median of 8.5 hours during another study to determine the minimum alveolar concentration of sevoflurane using a visceral stimulus. Gastric and small bowel motility were determined using a sensor capsule that measures pressure, pH and temperature. Gastric transit time and motility index were calculated. For 8/12 dogs, gastric motility, pH and transit time were measured. In 4/12 dogs, small bowel motility and pH were measured.ResultsAnesthesia decreased gastric and small bowel motility but did not change luminal pH. Mean gastric contraction force decreased from median (range) 11 (8–20) to 3 (1–10) mmHg (p < 0.01) and gastric motility index decreased from 0.63 (0–1.58) to 0 (0–0.31; p = 0.01). Frequency of contractions did not change, 3.7 (1.6–4.4) versus 2.8 (0.1–5.1) contractions minute^?1 (p = 0.1). Gastric motility returned to normal 12–15 hours following anesthesia. Gastric emptying was prolonged from 12 (5.3–16) to 49 (9.75–56.25) hours (p < 0.01). Mean small bowel contraction force decreased from 34 (24–37) to 3 (0.9–17) mmHg (p < 0.02) and motility index decreased from 3.75 (1–4.56) to 0 (0–1.53; p = 0.02). Frequency of contractions did not change, 0.5 (0.3–1.4) versus 1.4 (0.3–4.6) contractions minute^?1 (p = 0.11). Small bowel motility returned within 2 hours after anesthesia. Laparoscopy did not result in changes to gastric or small bowel parameters beyond those produced by general anesthesia.Conclusions and clinical relevanceThe force of gastric and small bowel contractions decreased during sevoflurane anesthesia for laparoscopy. Although gastric motility returned to normal within 12–15 hours the impairment of gastric emptying lasted 30–40 hours, predisposing dogs to postoperative ileus.     

THE USE OF A BARIUM MEAL TO EVALUATE TOTAL GASTRIC EMPTYING TIME IN THE DOG

Total gastric emptying time was determined in nine mongrel dogs using a barium meal contrast procedure. Within the group, total gastric emptying time ranged from 7.0–15.0 hours. Comparison of the population mean showed a statistical difference (p − 0.01) from previously published values. Individual dogs showed consistent total gastric emptying time over three trials. The technique can be used to test the effect of a procedure on total gastric emptying time when a normal value has been established for the dog. Due to the wide range of normal values observed, evaluation of clinical patients could be difficult unless there is a gross abnormality in function.