complication including two with premature tube removal due to interference from the dog. One dog died due to septic peritonitis as a result; 30 dogs survived to discharge and there was no recurrence of GDV in 21 dogs with follow‐up at a median of 2.5 years (range 3 months to 5 years).
Figure 8.10 Series of intraoperative images showing the technique for belt‐loop gastropexy. (a) Seromuscular incision (yellow arrow) in the pyloric region to create a flap based on the serosal blood vessels. (b) The flap is undermined, taking care not to penetrate the submucosa (S). A stay suture has been placed in the tip of the flap (yellow arrow). (c) Parallel incisions in the body wall through the peritoneum and transverse abdominal muscle. The tissue between the incisions is undermined to create a tunnel, the “loop.” (d) The flap has been passed caudal to cranial through the loop and sutured back in place with absorbable suture material.
Source: Courtesy of Dan Brockman.
Circumcostal Gastropexy
A circumcostal gastropexy is similar to a belt‐loop gastropexy but the seromuscular flap is passed around the last rib, although there are several variations of the technique [60, 67, 77]. Studies have reported a recurrence rate of 0–6.9% for circumcostal gastropexy [60, 63, 66, 77, 78]. This technique has been associated with complications including pneumothorax and rib fracture [60, 77]. Although greater tensile strength compared with other techniques has been identified [66], the importance of this strength is questionable; the authors of this chapter do not believe that it offers any significant advantage over incisional or belt‐loop gastropexy.
Figure 8.11 Series of intraoperative images showing the technique for tube gastropexy. (a) Stab incision in right abdominal wall, caudal to the last rib. (b) The stomach tube (a mushroom‐tipped catheter) is passed through the stab incision with the aid of forceps. (c) The tip of the catheter is being placed into the gastric lumen through a stab incision in the center of a preplaced purse‐string suture. (d) The first of four “box” sutures has been placed between the abdominal wall and stomach. (e) The four sutures have been placed, completing the tube gastropexy. The tube is anchored to the skin with a Roman sandal suture.
Other Techniques
Two additional techniques, gastrocolopexy and incorporating gastropexy, have been described. The proposed benefit of these techniques is that they are simpler and quicker to perform than other methods. However, it has not been shown that anesthesia or surgical time is associated with outcome in dogs with GDV and the authors do not believe that these techniques provide an advantage over other methods in most circumstances [7, 23]. Both have potential drawbacks [45, 78, 79]. However, one study reported the long‐term results of incorporating gastropexy in 203 dogs with GDV [80]. Recurrence of clinical signs of gastric dilatation or GDV occurred in 13 dogs (6.4%) at a median follow‐up of 20 months (range 3–50 months). In addition, 13 dogs (6.4%) subsequently underwent exploratory celiotomy without apparent issues due to the gastropexy. Nevertheless, the authors would not recommend the routine use of incorporating gastropexy or gastrocolopexy.
Following gastric repositioning and gastropexy, the abdomen is lavaged and closed in a routine fashion. Provided that all aspects of preoperative stabilization and anesthesia are appropriate, anesthesia and surgical time have not been associated with mortality [7, 23].
Postoperative Care
Postoperative care can be intensive and particular attention should be given to fluid therapy to ensure adequate hydration, the administration of appropriate pain relief, and maintaining adequate nutrition. Hypovolaemia, if still present, should be treated aggressively and may occur from continued fluid loss from the gastrointestinal tract as well as into the peritoneal cavity. Parameters that should be monitored closely include mucous membrane color and capillary refill time, PCV and total solids, acid–base balance, and urine output. A continuous electrocardiogram is useful to evaluate for the presence of arrhythmias. Blood pressure monitoring (invasive or non‐invasive) is also useful, although non‐invasive blood pressure monitoring can be challenging in the presence of arrhythmias. Placing an indwelling urinary catheter will allow measurement of urine output to help monitor perfusion status and as many of these dogs are recumbent for a period following surgery, can help to keep them comfortable. Mobilization as soon as possible after surgery should be encouraged. As long as there are no contraindications to feeding, water should be offered as soon as the dog is awake and food shortly afterwards. Intravenous fluid therapy can then be weaned gradually, over the next 48–72 hours. Because of the concern regarding compromise to the gastric mucosa, histamine‐2 receptor antagonists (famotidine), proton‐pump inhibitors (omeprazole, pantoprazole) and coating agents (sucralfate) should be considered.
Complications
Complications are common following GDV surgery and include arrhythmias, gastric necrosis or dehiscence, ileus/inappetence, acute kidney injury, DIC and sepsis. Postoperative complications such as acute kidney injury, DIC and sepsis have been associated with increased mortality in one study [9]. This study found that dogs requiring partial gastrectomy are at increased risk for the development of peritonitis, DIC, sepsis and arrhythmias, but were not at increased risk of death [9].
Postoperative Arrhythmias
Postoperative arrhythmias are frequently ventricular in origin and an electrocardiographic diagnosis is highly recommended prior to therapy. Indications and recommendations for therapy have been previously discussed in this chapter. If a ventricular arrhythmia is noted postoperatively, other causes should be ruled out including hypoxemia, anemia, pain, electrolyte abnormalities (particularly potassium or magnesium) or pre‐existing cardiac disease.
Gastric Necrosis, Ulceration or Dehiscence
If gastric necrosis is identified at surgery and not treated, there is a 100% risk of dehiscence [42]. Gastric perforation and leakage is associated with peritonitis and sepsis, and therefore manifests systemically as pain, hypoperfusion, and often vomiting. If these signs are identified in the postoperative period, evaluation for the presence of abdominal effusion and if present, fluid cytology is highly recommended.
Recurrent Gastric Dilatation
Although a properly performed gastropexy will prevent recurrence of volvulus, it does not prevent recurrent bloat. This is more of a problem in dogs with the chronic form of the disease. In these situations, management can be challenging, but possible interventions include a diet trial, in case of dietary insensitivity or placement of a gastrostomy tube to allow continuing decompression. In dogs with chronic gastric volvulus (over a period of months) or recurrent gastric dilatation, the authors would recommend performing a tube gastropexy.
Ileus
Ileus is a common complication after abdominal surgery and is often seen after GDV surgery. Common causes of ileus, such as
