Laparoscopic Assisted Gastropexy

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Indications - Gastric dilatation and volvulus(GDV) is a life-threatening condition which occurs in dogs. The condition involves distention of the stomach with air and twisting of the stomach so that the air cannot escape. This results in damage to the stomach tissue and shock due to the effects of the enlarged stomach on the nearby vessels. The condition is usually fatal without surgery. The underlying cause has not been determined, but there are predisposing factors which have been associated with the condition. The condition is most common among large breed dogs such as German shepherds, Labrador retrievers, golden retrievers, Great Danes, Standard Poodles, and other similar breeds. Heavy exercise and large meals have also been associated with GDV. In these breeds a procedure can be performed to affix a portion of the stomach to the body wall, called a prophylactic gastropexy. The procedure prevents the stomach from twisting if it does fill with air. The procedure is indicated in large breed, deep chested dogs, especially dogs who will at times be away from the possibility of quick veterinary care or who may be alone for periods of time during which they could have problems.

Procedure - A prophylactic gastropexy has traditionally been performed through a large open abdominal incision. However, using laparoscopic (surgery with the aid of fiber optics) techniques we can now perform the procedure through two small incisions. One incision is 1cm of length at the bellybutton with a second incision 3cm in length behind the ribs on the right side of the abdomen. The surgical procedure takes approximately 45 minutes. Research has shown that the adhesion formed between the stomach and body wall is permanent and of similar strength to older methods.

Insertion of the Laparoscope Used to Perform the Procedure

Post-operative recovery - Generally recovery is more rapid from the laparoscopic procedure because the incisions in the abdomen are much smaller. Dogs should be feeling well the day after surgery. Exercise should be limited to leash walks for a period of 3 days after the procedure. At that time mild activity and training can be undertaken. Heavy activity or work should wait until seven days after the procedure. At seven days post procedure the animal can return to normal activity and work. Skin sutures can be removed at 10 days postoperatively. No further care or precautions are necessary at that point.

Possible complications - Complications are very unlikely with the procedure. Complications which could occur include:

• Seroma – an accumulation of fluid under the skin at the larger incision site. This is not a serious complication and will typically resolve with some time.
• Carbon dioxide entrapped under the skin – carbon dioxide is used to expand the abdomen during the procedure. Rarely some can leak under the skin. This typically resolves within 12 hours.
• Other complications are those encountered with any surgery, there are very low risks of infection or problems with anesthesia.

Conclusion - Overall the procedure provides a minimally invasive means of preventing a potentially fatal disease. Owners as a whole have been very pleased with the results and speed of recovery from the procedure.

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