Occurrence and recurrence of gastric dilatation with or without volvulus after incisional gastropexy

This study investigated recurrence of gastric dilatation without (GD) or with volvulus (GDV) after incisional gastropexy (IG) in dogs that underwent IG for prevention of GDV. Signalment, concurrent surgical procedures, presence of GD or GDV at the time of IG were obtained from medical records of dogs that underwent IG. Owners were contacted to determine whether the dogs experienced GD or GDV after IG, dates of postoperative GD or GDV episodes, survival status, date of death for deceased dogs. Gastric dilatation and GDV recurrence rates were calculated for 40 dogs that had at least 2 y follow-up from the time when IG was performed and for dogs that experienced GD or GDV during the follow-up period. No dogs experienced GDV after IG and 2 dogs (5.0%) experienced GD after IG. The results suggest that GD and GDV rates after IG may be comparable to recurrence rates after other methods of gastropexy.     

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.     

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.     

Measurement of urinary 11-dehydro-thromboxane B2 excretion in dogs with gastric dilatation-volvulus

OBJECTIVE: To measure 11-dehydro-thromboxane B2 (11-dTXB2) in urine of healthy control dogs, dogs undergoing ovariohysterectomy, and dogs with gastric dilatation-volvulus (GDV) and assess the relationship between urinary 11-dTXB2 concentrations in dogs with GDV and postoperative outcomes. SAMPLE POPULATION: Urine samples from 15 nonsurgical control dogs, 12 surgical control dogs, and 32 dogs with GVD. PROCEDURE: Urine samples were obtained from healthy pet dogs (ie, nonsurgical control dogs), dogs undergoing ovariohysterectomy at anesthetic induction and 1 hour following surgery (ie, surgical control dogs), and dogs with GDV at hospital admission and 1 hour following surgical derotation of the stomach (ie, GDV dogs). Urinary 11-dTXB2 concentrations were determined with an ELISA and normalized to urinary creatinine (Cr) concentrations by calculation of the 11-dTXB2 -to-Cr ratio. Differences in median 11-dTXB2 -to-Cr ratios among dogs and before and after surgery were analyzed. RESULTS: Urinary 11-dTXB2-to-Cr ratios did not differ between nonsurgical control dogs and surgical control dogs before or after surgery. Urinary 11-dTXB2-to-Cr ratios were significantly higher in GDV dogs at the time of hospital admission and 1 hour after surgery, compared with those of nonsurgical control dogs. Postoperative urine samples from GDV dogs had significantly higher 11-dTXB2-to-Cr ratios than postoperative urine samples from surgical control dogs. Median urinary 11-dTXB2-to-Cr ratios increased significantly in GDV dogs that developed postoperative complications. CONCLUSIONS AND CLINICAL RELEVANCE: Urinary 11-dTXB2 concentration is increased in GDV dogs at the time of hospital admission and after surgical derotation of the stomach, compared with that of healthy dogs. An increased urinary 11-dTXB2-to-Cr ratio following surgery is associated with an increased incidence of postoperative complications in dogs with GDV.     

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.     

Prevention of reperfusion injury in surgically induced gastric dilatation-volvulus in dogs

Canine gastric dilatation-volvulus (GDV) is a naturally acquired condition of large-breed dogs primarily and is associated with high mortality. The clinical course suggests that reperfusion injury may be important in the pathogenesis of GDV. To evaluate the role of xanthine oxidase and iron-dependent lipid peroxidation (which are purported mechanisms of reperfusion injury) in the pathogenesis of GDV-related mortality, we created experimental GDV in 21 dogs. These dogs were then treated with either allopurinol (a xanthine oxidase inhibitor), U74006F (an experimental lipid peroxidation inhibitor), or saline solution (NaCl, 0.85%). Three of 8 dogs died in the allopurinol-treated group, none of 5 died in the U74006F-treated group, and 4 of 8 died in the saline solution-treated group. Tissue malondialdehyde concentration, a nonspecific indicator of lipid peroxidation, was significantly (P less than 0.05) greater in the duodenum, jejunum, colon, liver, and pancreas of the saline-solution treated and allopurinol-treated dogs than in the same tissues of the U74006F-treated dogs after surgical correction of the GDV (ie, during reperfusion), compared with malondialdehyde concentrations determined before inducing GDV. The results of this study support the concept that lipid peroxidation associated with reperfusion injury is important in the pathogenesis and high mortality of canine GDV. Furthermore, this lipid peroxidation and mortality may be preventable by appropriate and timely treatment.     

A Retrospective Study of Conservative Treatment of Gastric Dilatation-Volvulus in the Dog

A retrospective study of 103 dogs with gastric dilatation-volvulus (GDV) treated conservatively during the period 1985–1989 was performed. The date and number of recurrences, and the date and cause of death along with breed, age and sex were collected from clinic records and from a questionnaire sent to the owners (77% response). The treatment consisted of emptying the stomach with a stomach tube, gastrocentesis if necessary and treating shock.All of the affected dogs were from moderate to large sized breeds and the study showed that particular breeds appear to be predisposed to GDV. The average age was 7.2 years and there was no gender predisposition. Sixty-six per cent of the dogs survived the initial treatment and 50% of the dogs were still alive 1 month after treatment. Thirty-nine dogs (71%) received recurrence between 5–760 days after initial treatment. Fifty-six per cent had recurrence within 3 months and all except 2 dogs, within 1 year. Data for the time of death, regardless of cause, was available for 68 dogs. Of these 59 (81% ) died within a year after initial treatment. Conservative treatment was found to be an adequate life-saving procedure in the acute stage of GDV, but could not alone prevent recurrence of the disease.     

Diet-related risk factors for gastric dilatation-volvulus in dogs of high-risk breeds

A nested case-control study was conducted among 1634 dogs with complete diet information in a 5-year prospective study to determine diet-related risk factors for gastric dilatation-volvulus (GDV). Cases included 106 dogs that developed GDV; controls included 212 dogs without GDV that were frequency matched to cases by year of GDV onset. Proportionate energy consumed from major food types and from carbohydrates was determined. Dogs were categorized as consuming either a low volume or high volume of food based on the median number of cups of food fed per kg of body weight per meal. Dogs fed a larger volume of food per meal were at a significantly (P<0.05) increased risk of GDV, regardless of the number of meals fed daily. For both large- and giant-breed dogs, the risk of GDV was highest for dogs fed a larger volume of food once daily.     

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.     

Non-dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs

OBJECTIVE: To identify non-dietary risk factors for gastric dilatation-volvulus (GDV) in large breed and giant breed dogs. DESIGN: Prospective cohort study. ANIMALS: 1,637 dogs > or = 6 months old of the following breeds: Akita, Bloodhound, Collie, Great Dane, Irish Setter, Irish Wolfhound, Newfoundland, Rottweiler, Saint Bernard, Standard Poodle, and Weimaraner. PROCEDURE: Owners of dogs that did not have a history of GDV were recruited at dog shows, and the dog's length and height and the depth and width of its thorax and abdomen were measured. Information concerning the dog's medical history, genetic background, personality, and diet was obtained from the owners, and owners were contacted by mail and telephone at approximately 1-year intervals to determine whether dogs had developed GDV or died. Incidence of GDV, calculated on the basis of dog-years at risk for dogs that were or were not exposed to potential risk factors, was used to calculate the relative risk of GDV. RESULTS AND CLINICAL RELEVANCE: Cumulative incidence of GDV during the study was 6% for large breed and giant breed dogs. Factors significantly associated with an increased risk of GDV were increasing age, having a first-degree relative with a history of GDV, having a faster speed of eating, and having a raised feeding bowl. Approximately 20 and 52% of cases of GDV among the large breed and giant breed dogs, respectively, were attributed to having a raised feed bowl.     

Incidence of and breed-related risk factors for gastric dilatation-volvulus in dogs

OBJECTIVE: To compare incidence of and breed-related risk factors for gastric dilatation-volvulus (GDV) among 11 dog breeds (Akita, Bloodhound, Collie, Great Dane, Irish Setter, Irish Wolfhound, Newfoundland, Rottweiler, Saint Bernard, Standard Poodle, and Weimaraner). DESIGN: Prospective cohort study. ANIMALS: 1,914 dogs. PROCEDURE: Owners of dogs that did not have a history of GDV were recruited at dog shows, and the dog's length and height and depth and width of the thorax and abdomen were measured. Information concerning the dogs' medical history, genetic background, personality, and diet was obtained from owners, and owners were contacted by mail and telephone at approximately 1-year intervals to determine whether dogs had developed GDV or died. Incidence of GDV based on the number of dog-years at risk was calculated for each breed, and breed-related risk factors were identified. RESULTS AND CLINICAL RELEVANCE: Incidence of GDV for the 7 large (23 to 45 kg [50 to 99 lb]) and 4 giant (> 45 kg [> 99 lb]) breeds was 23 and 26 cases/1,000 dog-years at risk, respectively. Of the 105 dogs that developed GDV, 30 (28.6%) died. Incidence of GDV increased with increasing age. Cumulative incidence of GDV was 5.7% for all breeds. The only breed-specific characteristic significantly associated with a decreased incidence of GDV was an owner-perceived personality trait of happiness.     

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.     

Evaluation of splenectomy as a risk factor for gastric dilatation-volvulus

Objective-To evaluate whether dogs undergoing splenectomy had an increased risk of gastric dilatation-volvulus (GDV), compared with a control group of dogs undergoing enterotomy. Design-Retrospective case-control study. Animals-219 dogs that underwent splenectomy for reasons other than splenic torsion (splenectomy group; n = 172) or enterotomy (control group; 47) without concurrent gastropexy. Procedures-Medical records were reviewed for information on signalment, date of surgery, durations of surgery and anesthesia, reason for splenectomy, histopathologic findings (if applicable), whether gastropexy was performed, duration of follow-up, and date of death (if applicable). Follow-up information, including occurrence of GDV, was obtained via medical records review and a written client questionnaire. Results-Reasons for splenectomy included splenic neoplasia, nonneoplastic masses, infarction, traumatic injury, and adhesions to a gossypiboma. Incidence of GDV following surgery was not significantly different between dogs of the splenectomy (14/172 [8.1 %]) and control (3/47 [6.4%]) groups. Median time to GDV for the 17 affected dogs was 352 days (range, 12 to 2,368 days) after surgery. Among dogs that underwent splenectomy, sexually intact males had a significantly higher incidence of GDV (4/16) than did castrated males and sexually intact or spayed females (10/156). Incidence of GDV among sexually intact male dogs did not differ between groups. Conclusions and Clinical Relevance-Results did not support a recommendation for routine use of prophylactic gastropexy in dogs at the time of splenectomy. Other patient-specific risk factors should be assessed prior to recommending this procedure.     

Treatment of reperfusion injury in dogs with experimentally induced gastric dilatation-volvulus.

In dogs, gastric dilatation-volvulus (GDV) is characterized by cardiogenic shock, with resulting hypoperfusion. Treatment goals include reperfusion of transiently ischemic tissues, which indicates that reperfusion injury may be a factor in the physiopathogenesis of GDV. Recently, we obtained data that indicate that reperfusion injury may be involved in experimentally induced GDV. Using this GDV model, we evaluated mortality in 24 dogs of 4 equal groups, treated with deferoxamine (an iron chelator), dimethylsulfoxide (a free radical scavenger), a combination of the 2 drugs, or isotonic saline solution. All 6 dogs that were given deferoxamine survived; however, 3 dogs of the dimethylsulfoxide-treated group, 2 dogs of the combination-treated group, and 4 dogs of the saline-treated group died. Results of the study indicate that mortality associated with experimentally induced GDV is reduced by appropriate and timely pharmacologic intervention to prevent or attenuate reperfusion injury, and that deferoxamine may be more effective than dimethylsulfoxide.     

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.     

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.     

Assessment of the incidence of GDV following splenectomy in dogs

Objective : To establish if splenectomy increases the incidence of gastric dilatation and volvulus (GDV) in dogs. Methods : Two case-series studies of cases and controls were performed. Records of dogs that had undergone splenectomy (37 cases) were compared with records of dogs that had undergone other abdominal surgery (43 cases). Records of dogs that presented for non-elective gastropexy (33 cases) were compared with records of dogs presented to the hospital for unrelated reasons (39 cases). Survival following splenectomy and development of GDV in the first 12 months following surgery were retrieved from the clinical records and by questionnaire-based canvassing of the referring clinician. The incidence of GDV following splenectomy was established and the association between a current episode of GDV and previous splenectomy was assessed. Results : There was no evidence that splenectomy was associated with an increased incidence of subsequent GDV (P=0·469). No association between a current episode of GDV and previous splenectomy was found. Clinical Significance : Splenectomy is not associated with an increase in the incidence of GDV.     

Influence Of Allopurinol On The Pathophysiology Of Experimental Gastric Dilatation-Volvulus

Gastric dilatation-volvulus (GDV) was surgiclly induced in 10 dogs. Five of the dogs were pretreated with 50 mg/kg PO of allopurinol to determine the effect of xanthine oxidase inhibition on the pathophysiology of GDV. After 150 minutes, the GDV was corrected, and lactated Ringer's solution was administered intravenoulsy (resuscitation). Two hundred forty minutes after relief fo GDV, the dogs were euthanatized without recovery from anesthesia. Administration of allopurinol was associated with a reduced (P<0.01) incidence of hepatic necrosis and a lower (P<0.045) serum phosphorus level than observed in the control group at the end of the experiment. The increase in base deficit in the allopurinol-treated group after resuscitation was also less(P<0.045) than the control group. In conclusion, this study suggests that inhibition of xanthine oxidase-derived oxygen free radicals protects against hepatic necrosis in dogs with GDV. Resuscitation appears to be a time of profound physiologic stress for dogs with GDV.     

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.     

Intracellular magnesium concentrations in dogs with gastric dilatation-volvulus

OBJECTIVE: To quantify and compare intracellular magnesium concentrations (Mgi) in clinically normal dogs (control dogs) and dogs that have gastric dilatation-volvulus (GDV dogs) and to determine whether there is a difference in Mgi and serum magnesium concentrations (Mgs) between GDV dogs with and without cardiac arrhythmias. ANIMALS: 41 control dogs and 21 GDV dogs. PROCEDURE: Rectus abdominis muscle specimens were obtained from control and GDV dogs for determination of Mgi. Blood samples were obtained from GDV dogs for determination of Mgs, and dogs were monitored for 48 hours for cardiac arrhythmias. Muscle specimens were frozen at -40 C, oven dried at 95 C, and digested with concentrated nitric acid. Multielemental analyses were performed by simultaneous/sequential inductively coupled plasma-atomic emission spectroscopy with fixed-cross flow nebulization. The Mg, was standardized to sulfur content to correct for the amount of fat and fascia in the muscle specimen. Mean (+/- SEM) values were recorded in parts per million (ppm). Results-There were no significant differences in Mgi between control (627 +/- 11.1 ppm) and GDV (597 +/- 20.5 ppm) dogs, in Mgi between GDV dogs with (590 +/- 34 ppm) and without (584 +/- 29 ppm) cardiac arrhythmias, and in Mgs between GDV dogs with (1.77 +/- 0.26 ppm) and without (1.51 +/- 0.09 ppm) cardiac arrhythmias. There was no correlation between Mgs and Mgi (R2 = 0.0001). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that Mg depletion is not pathophysiologically important in dogs with GDV and does not play a role in the cardiac arrhythmias detected in these patients.