Minimally Invasive Gastropexy
Leigh Glerum, DVM, DACVS SAGE Redwood City
Unfortunately, we small animal veterinarians all have experience with gastric dilatation- volvulus (GDV). Onset of clinical signs is rapid, and the systemic deterioration of the affected dog can be as well. Overall mortality rates as high as 45% have been reported. The patient’s survival is dependent on prompt recognition of clinical signs and appropriate emergency stabilization–to include cardiovascular support and gastric decompression.
Gastropexy is strongly recommended for dogs suffering from GDV. Even if gastric position is self-corrected during the stabilization period, recurrence of torsion is highly likely (at least 80%). In an emergency situation, GDV patients are often stabilized and taken into the operating room for assessment and correction of gastric positioning, assessment of gastric and splenic viability, resection of stomach and spleen when necessary, and gastropexy. Post-operative hospitalization time generally ranges from 1-3 days.
Prophylactic gastropexy should be considered in large dogs of deep chested conformation— such as the Great Dane, Standard Poodle, German Shepherd, and Saint Bernard. Prophylactic gastropexy should be considered even more strongly for those dogs with a personal history of bloat/GDV or a familial history of GDV in a first order relative (parent or sibling). Prophylactic gastropexy may be performed via laparotomy or laparoscopy.
Laparoscopic assisted gastropexy is a fairly quick and simple procedure. Only 2 short incisions are required and the resulting adhesion (gastropexy) has been demonstrated to be durable and strong, very similar and even superior to certain methods of open gastropexy. Patient discomfort is minimized due to diminished incisional length and surgical manipulations. Patients are monitored closely during the initial anesthetic recovery period (particularly those individuals who have a personal history of GDV/bloat), but hospitalization time is generally no longer than 1 day. Activity is restricted to leash walks for the first 2 weeks to help insure adequate gastropexy healing.
In younger female dogs, prophylactic laparoscopic assisted gastropexy may be performed concurrently with ovariohysterectomy. OHE may be done in a completely closed fashion via laparoscope, aided by electrical hemostatic devices such as the Ligasure.