Ultrasonographic comparison of adhesions induced by two different methods of gastropexy in the dog

Ultrasonography was used to compare adhesions induced by two different methods of gastropexy in 16 dogs. An incisional gastropexy technique was used in eight dogs (group 1) and a 'modified' gastropexy technique in the remaining eight (group 2). The length and thickness of the gastropexy and the peristaltic activity of the stomach were measured ultrasonographically and compared between groups. Measurements for the two groups were taken in the early postoperative interval (two to four days), intermediate postoperative interval (eight to 20 days) and late postoperative interval (57 to 79 days). Both techniques were equally successful in forming permanent adhesions at two months postoperatively and there was no recurrence of gastric dilatation and volvulus. The length and thickness of the gastropexy were similar for both groups at two months postoperatively and there were no surgical complications with either technique. The modified gastropexy provides a technique that can easily be performed by a single surgeon , with no increased operative time or duration of anaesthesia, and with the formation of a permanent adhesion.     

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.     

Tube gastrostomy in dogs

Tube gastrostomy was performed in 19 dogs over a period of 36 months. Indications for tube gastrostomy included non-oral feeding for the management of oesophageal injuries (nine cases) and dysphagia resulting from oral or pharyngeal trauma (two cases) and decompression and, or, gastropexy for gastric diseases including gastric dilatation volvulus (four cases), gastric outflow diseases (three cases) and gastric neoplasia (one case). All the tubes were placed surgically and left in situ for periods of up to 14 days. Feeding was by frequent bolus administration of a proprietary enteral food initially followed by homogenised commercial dog food. The tubes were readily managed and patency maintained in all cases. Gastric stomata granulated within three days of tube removal. Fourteen dogs recovered and returned to normal oral feeding while three died as the result of their presenting condition. A fourth was euthanased four months after surgery because of recurrence of a gastric malignancy. This review indicates that surgically placed tube gastrostomy is readily performed and is an effective means of providing non-oral alimentation and, or, gastric decompression.     

Recurring gastric volvulus in a dog

A successful prophylactic permanent gastropexy was performed on a dog that had previously experienced four gastric volvulus procedures, one prophylactic pyloroplasty, and two subsequent gastric volvulus repairs. Radiographic evaluation of the previous pyloroplasty and the final permanent gastropexy are illustrated.     

Intermittent gastric dilatation after gastropexy in a dog.

Gastroperitoneal adhesions, which developed after tube gastrostomy in a 3-year-old dog, caused an inverted L configuration of the pyloric antrum and duodenum, resulting in periodic episodes of gastric dilatation. The dog had undergone tube gastrostomy for treatment of gastric dilatation/volvulus, but gastropexy adhesions broke down 27 months later, necessitating a second pexy procedure. Adhesions then developed, constricting gastric outflow and trapping gas in the stomach and proximal duodenum. When the ventral row of adhesions was surgically dissected, the angle between the pyloric antrum and the duodenum was straightened, facilitating flow of digesta. Gastropexy rarely causes the degree of adhesion formation and the complications reported in this dog.     

Gastropexy with an automatic stapling instrument for the treatment of gastric dilatation and volvulus in 20 dogs

Surgical stapling equipment was used to create a gastropexy in 20 dogs undergoing emergency surgery for gastric dilatation and volvulus (GDV). The technique involved creation of a tunnel between the seromuscular layer and the submucosa of the pyloric antrum, and a matching tunnel beneath the right m. transversus abdominis. The arms of a gastrointestinal anastomosis stapling device were introduced into the tunnels, and the device was fired to create the gastropexy. One dog died of systemic sequelae of GDV during the early postoperative period. None of the remaining 19 dogs developed a recurrence of GDV during follow-up periods ranging from 5 to 43 months. In 11 dogs, the integrity of the gastropexy was evaluated by abdominal ultrasonography and either negative contrast gastrography or double contrast gastrography; in these dogs, the radiographic and/or the ultrasonographic findings were suggestive of an intact gastropexy. There were no complications involving the gastropexy staple line. The results of this study indicate that an effective and consistent permanent gastropexy can be created, using surgical stapling equipment.     

Clinical evaluation of a right-sided prophylactic gastropexy via a grid approach

A new technique is described for a prophylactic incisional gastropexy via a right-sided grid approach (i.e., minilaparotomy). A pilot study showed comparable tensile strength between a traditional ventral midline approach and the grid approach. Six client-owned dogs were selected for the procedure. Four weeks postoperatively, a barium gastrogram was performed to assess stomach/gastropexy position. Complications included a seroma and postoperative discomfort. This technique should be considered for any at-risk breed that is not overweight. The right-sided grid approach to a prophylactic gastropexy was less invasive than a ventral midline approach and resulted in a stable gastropexy at 4 weeks postoperatively in five of six dogs.     

Belt loop gastropexy in the management of gastroesophageal intussusception in a pup.

Gastroesophageal intussusception and megaesophagus were diagnosed in a 5-week-old German Shepherd Dog. Exploratory surgery was performed, and belt loop gastropexy was used to maintain proper gastric position after manual reduction of the intussusception. The pup survived surgery and was clinically normal when it was 6 months old. Follow-up contrast radiography revealed resolution of the megaesophagus and apparent permanent gastropexy. Previous reports have indicated extremely high mortality for gastroesophageal intussusception, and resolution of megaesophagus in the dog is unusual.     

Oesophageal hiatal hernia in two cats

Sliding oesophageal hiatal hernia was diagnosed radiographically in two domestic short-haired cats. The hernias were corrected by hiatal tightening, modified Nissen fundoplication and permanent gastropexy. One cat recovered without complication, and the other developed severe necrotic gastritis following surgery. Both cats were asymptomatic and had normal radiographic studies nine months and one year after surgery.     

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.     

A Comparison of Laparoscopic and Belt-Loop Gastropexy in Dogs

A simplified technique for laparoscopic gastropexy (group 1) was compared to belt-loop gastropexy (group 2) in eight adult male dogs randomly divided into two groups of four dogs each. Our hypothesis was that a satisfactory laparoscopic gastropexy would approximate the strength and operative time required for belt-loop gastropexy. Operative time, surgical complications, postoperative morbidity, gross and histological appearance, radiographic microvascularization, and maximal tensile strength were measured and compared between the two groups. All dogs recovered from surgery. No morbidity was associated with either procedure. The mean (±SD) duration of surgery was 69.75 ± 7.23 minutes for group 1 and 58.75 ± 7.63 minutes for group 2. Fifty days after surgery, the microvascular appearance of the gastropexy site was similar for both groups. Blood vessels were observed within each seromuscular flap but vascular ingrowth to the abdominal musculature was observed in only two dogs, one from each group. The maximum tensile strength at 50 days was 76.55 ± 22.78 for group 1 and 109.21 ± 22.29 N for group 2. Differences between surgical duration and maximum tensile strength were not statistically significant ( P >.05). Histologically, all gastropexies consisted of an adhesion composed of dense fibrous connective tissue. The results of this study indicate that laparoscopic gastropexy provides a minimally invasive alternative to open abdominal prophylactic gastropexy in dogs.     

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.     

Ventral marsupialisation in the treatment of gastric dilatation-volvulus in two dogs

A ventral marsupialisation technique is described which was used successfully to manage gastric dilatation-volvulus (GDV) in two large breed dogs. The procedure allowed the stomach to be completely and rapidly emptied and lavaged without peritoneal contamination. Drainage was maintained in the postoperative period for both dogs and the technique was expected to result in a permanent ventral gastropexy.     

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.     

Circumcostal gastropexy for preventing recurrence of gastric dilatation-volvulus in the dog: an evaluation of 30 cases

Follow-up evaluation (mean, 13.7 months) was obtained in 30 dogs with gastric dilatation-volvulus that were surgically treated with circumcostal gastropexy. Evaluation was performed by questionnaire (29 dogs), radiographic contrast studies (23 dogs), and necropsy (6 dogs). The gastropexy was thought to be intact in all 23 dogs examined radiographically. Necropsy of 6 dogs dying from causes unrelated to gastric dilatation-volvulus (mean of 12.7 months after surgery) revealed an intact gastropexy site in each dog. Only 1 (3.3%) dog had clinical recurrence of gastric dilatation after surgery. Five additional dogs dying postoperatively were necropsied and had intact gastropexy sites.     

Recurrence of gastric dilatation-volvulus after incisional gastropexy in a rottweiler

An adult, castrated male rottweiler with a history of gastric dilatation-volvulus (GDV), which was treated 4 months previously by surgical gastric resection and incisional gastropexy, had a recurrence of clinical signs. Abdominal exploratory surgery revealed a 180 degrees -clockwise GDV, with a stretched adhesion at the original gastropexy site. The stomach was repositioned, and additional gastropexies were performed adjacent to the original gastropexy site and at the gastric fundus. The recurrence of GDV in this dog with an intact gastropexy suggested that a risk for volvulus remains after therapeutic incisional gastropexy.     

Hiatal hernia in a shar-pei

A combined axial and paraoesophageal hiatal hernia complicated by splenic involvement was diagnosed in a two-year-old Chinese shar-pei. A circumcostal gastropexy was performed following reduction of the hernia and fundoplication of the cardia The dog recovered well and is asymptomatic six months postoperatively. The literature concerning hiatal hernia in the dog is reviewed and the various surgical techniques described for its management are discussed.     

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.     

Partial Gastrectomy with an Automatic Stapling Instrument for Treatment of Gastric Necrosis Secondary to Gastric Dilatation-Volvulus

A gastrointestinal anastomosis stapling instrument was used to perform partial gastrectomy in nine dogs undergoing emergency surgery for gastric dilatation-volvulus. The amount of necrotic stomach resected was 20% to 50%. Permanent gastropexy was performed, and six dogs also required partial or total splenectomy. Six dogs (67%) were normal after surgery, with follow-up periods of 6 to 16 months for five dogs. One dog died and two dogs were euthanatized because of postoperative complications unrelated to the surgical technique. There were no complications involving the partial gastrectomy staple line.     

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.