Prospective evaluation of laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation

OBJECTIVE: To determine long-term outcome associated with laparoscopic-assisted gastropexy in prevention of gastric dilatation-volvulus (GDV) in susceptible dogs and to evaluate use of laparoscopy to correct GDV. DESIGN: Prospective study. ANIMALS: 25 client-owned large-breed dogs. PROCEDURE: 23 dogs susceptible to GDV were referred as candidates for elective gastropexy. These dogs had a history of treatment for gastric dilatation, clinical signs of gastric dilatation, or family members with gastric dilatation. Laparoscopic-assisted gastropexy was performed. One year after surgery, abdominal ultrasonography was performed to evaluate the attachment of the stomach to the abdominal wall. Two dogs with GDV were also treated with laparoscopic-assisted derotation of the stomach and gastropexy. RESULTS: None of the dogs developed GDV during the year after gastropexy, and all 20 dogs examined ultrasonographically had an intact attachment. Another dog was euthanatized at 11.5 months for unrelated problems. Two dogs with GDV successfully underwent laparoscopic-assisted gastropexy after the stomach was repositioned. CONCLUSIONS AND CLINICAL RELEVANCE: Laparoscopic-assisted gastropexy resulted in a persisting attachment between the stomach and abdominal wall, an absence of GDV development, and few complications. Dogs with a high probability for development of GDV should be considered candidates for minimally invasive gastropexy. Carefully selected dogs with GDV can be treated laparoscopically.     

Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation-volvulus

This prospective study describes a simple method of combining laparoscopic ovariectomy and laparoscopic-assisted prophylactic gastropexy and determines the duration of surgery, complications, and long-term outcome including prevention of gastric dilatation-volvulus (GDV). Laparoscopic ovariectomy and laparoscopic-assisted gastropexy were performed on 26 sexually intact female dogs susceptible to GDV. The mean surgery time was 60.8 ± 12.4 min. No GDV episode was seen during the study period (mean follow-up: 5.2 ± 1.4 y). All dogs had an intact gastropexy attachment assessed by ultrasonography at 1 y. Post-operative complications were minor and owners were satisfied with the procedure. Combined laparoscopic ovariectomy and laparoscopic- assisted gastropexy appears to be a successful and low morbidity alternative procedure to both ovariectomy/ovariohysterectomy and gastropexy via open ventral-midline laparotomy.     

Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy utilizing a 2-port technique in 10 dogs

A case series was selected retrospectively to evaluate the technique, outcome, and short-term complications associated with a combined laparoscopic ovariectomy (Lap OVX) and laparoscopic-assisted gastropexy (LAG) using a 2-port technique, and to compare it with previously published combined laparoscopic techniques for Lap OVX and LAG in dogs. Medical records of dogs undergoing elective, combined Lap OVX and LAG performed using a 2-port technique between 2017 and 2019 were reviewed. Total surgical time was compared to previously published combined Lap OVX and LAG techniques in dogs. Intraoperative and short-term complications were recorded. Ten dogs [median weight: 29.4 kg (range: 11.4 to 84.1 kg); mean: 37.4] met the inclusion criteria. Median surgical time to complete both the Lap OVX and LAG was 72.5 minutes (range: 47.0 to 120.0 minutes; mean: 77.4 minutes), which was not significantly different than that described in previous studies of combined Lap OVX and LAG (weighted mean average: 67.3 minutes; 95% confidence interval: 46.9 to 87.7, P = 0.3). No intraoperative or postoperative complications were reported. It is concluded that a 2-port technique for combined Lap OVX and LAG is feasible, has few complications, and requires similar time to perform compared to other previously published laparoscopic techniques.     

Use of laparoscopic-assisted cryptorchidectomy in dogs and cats

A laparoscopic-assisted technique for localization and removal of retained testes was performed on 13 client-owned dogs and cats. Operative time and intraoperative complications were recorded. One month after surgery, follow-up examinations were performed on all animals and owners were asked to complete questionnaires concerning signs of illness and complications observed after surgery and their overall satisfaction with the procedure. The laparoscopic-assisted technique was effective in identifying and removing retained testes. Owners were satisfied with the procedure. Laparoscopic-assisted crytorchidectomy can be used to minimize the invasiveness of the procedure while maintaining the safety associated with good visibility of abdominal structures.     

A wound retraction device for laparoscopic-assisted intestinal surgery in dogs and cats

Objectives: To report experience with laparoscopic‐assisted intestinal resection and anastomosis for treatment of discrete intestinal masses using a novel wound retraction device. Study Design: Case series. Animals: Dogs (n=2) and cats (6). Methods: Dogs and cats with discrete intestinal masses identified by ultrasonography without evidence of intestinal perforation or peritonitis, were included. A 2 portal technique was used; 1 portal was enlarged for insertion of the wound retraction device through which the intestine was examined as thoroughly as possible. The diseased portion of the intestine was exteriorized through the wound retractor and resection and anastomosis of the intestinal mass performed. Results: Of the 8 animals, laparoscopic‐assisted intestinal resection and anastomosis through the wound retractor was performed in 2 dogs and 3 cats. In 3 cats, based on either location or extent of the lesion, 2 were converted to laparoscopic‐assisted intestinal biopsies and 1 to an open colocolostomy. No other intra‐ or perioperative complications were encountered and all animals survived to discharge. Conclusions: Laparoscopic‐assisted intestinal resection and anastomosis can be performed in select canine and feline patients with modestly sized, discrete intestinal masses.     

Evaluation of an endoscopically assisted gastropexy technique in dogs

OBJECTIVE: To evaluate the use of endoscopy in conjunction with a gastropexy technique in dogs as a potential means to aid prevention of gastric dilatation-volvulus. ANIMALS: 12 healthy adult medium- and large-breed dogs. PROCEDURES: 12 adult research dogs that had no abnormal physical examination findings each underwent an endoscopically assisted gastropexy procedure. On completion of the procedure, the dogs were euthanized and exploratory laparotomies were performed to evaluate the surgical site. Data recorded included anatomic location of the gastropexy, gastropexy length, and duration of procedure as well as any complications. RESULTS: Mean+/-SD gastropexy length was 3.3+/-0.25 cm, and mean duration of surgery was 18+/-7 minutes. In each dog, the stomach was located in its normal anatomic position and all gastropexies were sutured to the abdominal wall at the level of the pyloric antrum. The only complications during the procedure were needle bending and breakage at the time of stay suture placement. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of these findings, it appears that endoscopically assisted gastropexy is a simple, fast, safe, and reliable method of performing a prophylactic gastropexy in dogs when undertaken by a person who is skilled in endoscopy. Such a procedure maximizes the benefits of decreased morbidity and shorter duration of anesthesia associated with minimally invasive surgery. Further clinical studies are warranted to evaluate the long-term efficacy of this procedure in dogs at risk for development of gastric dilatation-volvulus.     

Ultrasonographic evaluation of adhesions induced by incisional gastropexy in 16 dogs

A study was undertaken to evaluate the use of ultrasonography to assess the gastropexy site for permanent adhesion in clinical cases. Two groups, each comprising eight dogs, were studied, all 16 cases undergoing decompression, anatomical repositioning of the stomach and an incisional gastropexy after gastric dilatation-volvulus (GDV). Group 1 was set up as a prospective group in which ultrasonographic examinations were performed three times (mean three, 12 and 67 days) after surgery to evaluate the gastropexy region. The gastropexy site was assessed ultrasonographically at only one stage (mean 449 days after surgery) in the group 2 dogs. Criteria used to assess the usefulness of the ultrasonographic evaluation included the ability to identify the gastropexy site, to obtain measurements of the length and thickness of the site and to assess the ultrasonographic appearance of the different gastric wall layers. The average number of peristaltic contractions and degree of gastric filling were also evaluated. The fixation between the stomach and the abdominal wall was easily detected in all 16 cases. Ultrasonography proved to be a simple and non-invasive technique to assess the permanency of the gastropexy. The Incisional gastropexy was relatively easy to perform and induced permanent adhesions in all 16 dogs, without recurrence of GDV.     

Effect of circumcostal gastropexy on gastric myoelectric and motor activity in dogs

Gastric electrical and contractile activities were assessed in healthy adult dogs on the eighth day after circumcostai gastropexy surgery, using serosai electrodes and strain gauge force transducers. Recordings were anaiysed to determine gastric slow wave frequency, presence of gastric slow wave dysrhythmlas, gastric slow wave propagation velocity, coupling of gastric contractions to slow waves, a gastric motility index based on relative contractile amplitudes, and onset of gastric contractions after a standardized meal. Overall, gastric electrical and contractile activities were relatively unaffected by circumcostai gastropexy.     

Resection of inflammatory polyps in dogs using laparoscopic-assisted cystoscopy

Inflammatory polyps in the urinary bladder of two dogs were removed via laparoscopic-assisted cystoscopy. In addition, one dog had a calculus removed and liver biopsies taken using the same two trocar sites. The laparoscopic-assisted cystoscopic technique provided clear surgical margins and permitted a thorough examination of the inside of the bladder and urethra. The technique was minimally invasive, produced little abdominal injury, and limited urine contamination of the abdomen.     

Evaluation of a skin stapler for belt-loop gastropexy in dogs.

A new method for attachment of a belt-loop gastropexy using disposable, stainless steel skin staples was compared with a traditional hand-sewn belt-loop gastropexy technique in 24 fresh dog cadavers. Mean gastropexy times were 212 seconds for the stapled technique and 435 seconds for the hand-sewn technique. The stapled belt-loop gastropexy was significantly faster than the hand-sewn technique (P less than 0.001). There was no statistically significant difference in the mean maximum tensile strength between the two attachment methods. This study provides a basis for clinical evaluation of the stapled belt-loop gastropexy technique in dogs.     

Evaluation of laparoscopic-assisted placement of jejunostomy feeding tubes in dogs

OBJECTIVE: To evaluate feasibility of performing laparoscopic-assisted placement of a jejunostomy feeding tube (J-tube) and compare complications associated with placement, short-term feedings, and medium-term healing with surgically placed tubes in dogs. DESIGN: Prospective study. ANIMALS: 15 healthy mixed-breed dogs. PROCEDURES: Dogs were randomly allocated to undergo open surgical or laparoscopic-assisted J-tube placement. Required nutrients were administered by a combination of enteric and oral feeding while monitoring for complications. Radiographic contrast studies documented tube direction and location, altered motility, or evidence of stricture. RESULTS: Jejunostomy tubes were successfully placed in the correct location and direction in all dogs. In the laparoscopic group, the ileum was initially selected in 2 dogs, 2 dogs developed moderate hemorrhage at a portal site, and 2 J-tubes kinked during placement but were successfully readjusted postoperatively. All dogs tolerated postoperative feedings. All dogs developed minor ostomy site inflammation, and 1 dog developed bile-induced dermatitis at the ostomy site. Despite mild, transient neutrophilia, no significant difference was noted in WBC counts between groups. No dog had altered gastric motility or evidence of stricture, although the jejunopexy site remained identifiable in several dogs at 30 days. CONCLUSIONS AND CLINICAL RELEVANCE: Requirements for successful J-tube placement were met by use of a laparoscopic-assisted technique, and postoperative complications were mild and comparable to those seen with surgical placement. Laparoscopic-assisted J-tube placement compares favorably to surgical placement in healthy dogs and should be considered as an option for dogs requiring enterostomy feeding but not requiring a celiotomy for other reasons.     

Benefits of prophylactic gastropexy for dogs at risk of gastric dilatation-volvulus

The lifetime probability of death from gastric dilation–volvulus (GDV) for five dog breeds was estimated based on published breed-specific longevity and GDV incidence. These breeds were Great Dane, Irish Setter, Rottweiler, Standard Poodle and Weimaraner. Lifetime risk (95% CI) of GDV in these breeds ranged from 3.9% (0–11.2%) for Rottweiler to 36.7% (25.2–44.6%) for Great Dane.

A decision-tree analysis for prophylactic gastropexy—using lifetime probability of death from GDV and expected cost savings for veterinary services as outcome measures—was undertaken to determine the preferred course of action in several dog breeds. Prophylactic gastropexy was the preferred choice of action for all breeds examined, with the reduction in mortality (versus no gastropexy) ranging from 2.2-fold (Rottweiler) to 29.6-fold (Great Dane). Assuming a prophylactic gastropexy costs US$ 400, the procedure was cost-effective when the lifetime risk of GDV was ≥34%. The maximum and minimum estimated breakeven costs for the gastopexy procedure ranged from US$ 20 (Rottweiler) to US$ 435 (Great Dane). The cost-effectiveness of prophylactic gastropexy was most sensitive to the cost of treating GDV (US$ 1500). Prophylactic gastropexy raises ethical issues that need to be considered by veterinarians and dog breeders.     

Cardiopulmonary measurements in dogs undergoing gastropexy without gastrectomy for correction of gastric dilatation-volvulus.

OBJECTIVE: To measure cardiopulmonary variables, including cardiac index, in dogs with naturally acquired gastric dilatation-volvulus (GDV). DESIGN: Prospective clinical study. ANIMALS: 6 dogs with GDV. PROCEDURE: In addition to typical medical and surgical management of GDV, the dorsal metatarsal and pulmonary arteries and right atrium of the dogs were catheterized to obtain cardiopulmonary measurements before and during anesthesia and surgery. RESULTS: All dogs underwent gastropexy but none required gastrectomy. Mean cardiac index and mean arterial blood pressure for this small population of dogs with GDV were not significantly different from those reported for clinically normal awake or anesthetized dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Dogs with naturally acquired GDV without gastric necrosis may not have the classic characteristics, including decreased cardiac index and hypotension, of hypovolemic circulatory shock.     

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.     

Use of laparoscopic-assisted cystoscopy for removal of urinary calculi in dogs

Urinary calculi were removed by means of laparoscopic-assisted cystoscopy in 3 dogs. Two small abdominal incisions were made--1 for a laparoscope and 1 for placement of a Babcock forceps to aid in grasping and lifting the urinary bladder to the abdominal wall. A cystoscope and instruments for calculi removal were passed through a small cystotomy. Biopsy of the urinary bladder or other abdominal organs could also be performed by use of this technique. Laparoscopic-assisted cystoscopy was minimally invasive and provided clear images of the mucosal surface of the urinary bladder and proximal portion of the urethra for easy retrieval of urinary calculi. An imaging procedure should be performed to ensure complete removal of calculi.