Preventative Gastropexy and its Benefits
Those in the field of veterinary medicine are aware of gastric dilatation and volvulus syndrome (GDV), commonly known as bloat, and its dangers. The condition involves inflation of the stomach with gas, referred to as dilatation, and the stomach twisting, or volvulus; this can in turn decrease perfusion to other organs and lead to organ death. Although there are multiple theories, there is not one definitive cause of bloat; however, there are certain dog breeds more prone to the condition.
Deep chested as well as large- or giantbreed dogs are at a higher risk for this condition: Great Danes, St. Bernards, German Shepherds, Doberman Pinschers, etc. Equipped with the awareness of which breeds are most commonly affected, those in the veterinary field can work to take preventative measures.
How can a pet owner identify bloat?
Symptoms of bloat vary, but some symptoms a pet owner should look out for include:
• An enlarged abdomen
• Pain upon abdominal palpation
As the condition progresses, it is possible that the dog may collapse or begin panting. It is essential the condition be treated as quickly as possible in order to prevent cell death in vital organs and the lining of the intestinal tract. Untreated, this condition can lead to kidney and liver failure as well as bacteremia and sepsis.
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What is a gastropexy?
A gastropexy is a procedure in which the stomach wall is adhered to the abdominal wall in order to prevent the stomach from flipping. Completed successfully, the procedure should not cause any complications to the stomach's natural placement or flow. Gastropexy is typically performed when a dog afflicted with GDV is brought in for treatment, in order to prevent condition recurrence. If done when the patient is young, this procedure could be coupled with a patient's castration or ovariectomy and could be used to preemptively prevent the occurrence of GDV.
There are several different types of gastropexy, including, but not limited to, laparoscopic-assisted and incisional gastropexy. A 2011 study published in the Canadian Veterinary Journal focused on combining laparoscopic ovariectomy with laparoscopic-assisted gastropexy in 26 dogs susceptible to GDV. The study included ten breeds: Bernese Mountain Dogs, Doberman Pinschers, German Shepherds, Great Danes, Irish Setters, Irish Wolfhounds, Labradors, Pyrenean Mountain Dogs, and Weimaraners. None of the animals involved in the study developed GDV following the procedure, and all were found to have their stomachs in the proper position following ultrasonographic examination a year following the procedure.
A study published in the Canadian Veterinary Journal in 2014 focused on incisional gastropexy, an open approach method as opposed to laparoscopic-assisted gastropexy's minimally invasive technique. The study's aim was to consolidate the medical records of all canines that underwent incisional gastropexy between 2004 and 2012; 82 dogs were included in the study. Of the dogs included in the study, none experienced GDV following incisional gastropexy, although two did experience gastric dilatation.
How can I be ready for a GDV patient?
Should you be expecting a GDV patient, there are a few things to prepare for. All proper monitoring equipment, surgical packs, and IV fluids should be set up within the surgical suite along with any emergency drugs, should they be necessary. When the patient arrives, technicians should begin by doing what they can to relieve pressure in the stomach, either via stomach tube or trocar. The catheter should be inserted and preanesthetic bloodwork drawn and ran. Radiographs should be performed in order to evaluate stomach, and sometimes spleen, rotation and the abdomen should be shaved for surgery.
What are the risks of performing a gastropexy?
As with any surgical procedure, risks depend on technique. It is not unlikely that minimally invasive forms of gastropexy pose less risk than open forms. In most cases described in the 2011 study of laparoscopicassisted gastropexy, surgical complications were minor: one dog suffered vomiting, and four developed seroma of the incision site; these complications resolved by six weeks following surgery. A retrospective study published in Volume 45, Issue S1 of Veterinary Surgery focused on 49 dogs following prophylactic laparoscopic-assisted gastropexy; 10% of the dogs experienced complications related to abdominal access, 4% experienced intraoperative complications and major postoperative complications, and 30% experienced minor postoperative wound-related complications. Regardless of these complications, 100% of the clients were satisfied with the procedure.
Is it worth it?
Ultimately, the choice of whether or not a patient should undergo preventative gastropexy is up to you and your client. Be sure to discuss cost, postoperative care, as well as the risks associated with the surgical procedure. However, it is worth noting that GDV has an incredibly high mortality rate, even if gastropexy is performed the day a GDV patient is brought in. It is worth taking advantage of the breed-specific knowledge we have today when deciding whether or not a patient would benefit from the procedure; in many cases, it is much better to be safe than sorry.
About the Author
Mara DePena has been working as a veterinary assistant in a number of hospitals and vaccine clinics since 2016. She obtained her B.S. in Animal and Poultry Sciences from Virginia Tech in 2018 with a companion and laboratory animal emphasis. She is especially interested in animal behavior and training.
Rawlings, C. A., Mahaffey, M. B., Bement, S., & Canalis, C. (2002). Prospective evaluation of laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation. Journal of the American Veterinary Medical Association,221(11), 1576-1581. Retrieved December 31, 2018, from www.ncbi.nlm.nih.gov/pmc/articles/ PMC3003578/.
Eggertsdóttir, A. V., Langeland, M., Fuglem, B., Mohn, A., & Stigen, Ø. (2008). Long-Term Outcome in Dogs After Circumcostal Gastropexy or Gastrocolopexy for Gastric Dilatation With or Without Volvulus. Veterinary Surgery, 37(8), 809-810.
Son, N. K., Singh, A., Amsellem, P., Kilkenny, J., Brisson, B. A., Oblak, M. L., & Ogilvie, A. T. (2016). Long-Term Outcome and Complications Following Prophylactic Laparoscopic-Assisted Gastropexy in Dogs. Veterinary Surgery,45(S1).
Acute GDV Surgery: What You Need to Know. (2012, October 23). Retrieved January 10, 2019, from www.canadianveterinarians.net/documents/acute-gdv-surgery-what-you-need-to-know Gastric Dilatation-Volvulus. (n.d.). Retrieved January 10, 2019, from www.acvs.org/small-animal/gastric-dilatation-volvulus