Background: Gastric dilatation-volvulus (GDV) syndrome in dogs is a potentially fatal condition that can currently only be prevented surgically. The goal of prophylactic gastropexy is to secure the pyloric antrum to the right abdominal wall, preventing cranial and leftward displacement of the pylorus. Among the various surgical techniques described, minimally invasive approaches are currently preferred. This study presents a simplified technique for laparoscopic-assisted prophylactic gastropexy (LAG). Methods: A case series study was conducted on 40 client-owned dogs to assess the feasibility (i.e., the likelihood of successful completion) and efficacy of a modified laparoscopic-assisted prophylactic gastropexy (LAG). The original Rawlings video-assisted technique (2001) involves an incisional gastropexy with laparoscopic assistance, requiring exteriorization of part of the antral gastric wall, incision of the stomach to expose the gastric mucosa, and subsequent suturing seromuscular layers of the stomach to the transversus abdominis muscle. Additionally, the abdominal musculature encountered during the surgical approach—caudal to the last rib and lateral to the rectus abdominis muscle—is incised. In the modified technique described herein, a more delicate grid approach was used for muscle dissection, and both stomach exteriorization and gastric wall incision have been avoided. This modification aimed to reduce invasiveness and potentially minimize postoperative pain. The efficacy of this modified gastropexy in preventing GDV was assessed based on the presence of adhesions between the transversus abdominis muscle and the pyloric antrum. Adhesion formation was evaluated via ultrasound at 1, 3, and 6 months postoperatively. The technique was considered effective if ultrasound confirmed adhesion formation and if no cases of GDV occurred throughout the study period. Intraoperative and postoperative complications, as well as any occurrence of GDV, were also recorded and analyzed. Results: At the scheduled follow-up evaluations at 1 and 3 months, all dogs (n = 40; 100%) examined via ultrasound demonstrated adhesion formation at the gastropexy site. At the 6-month ultrasound follow-up, 32 dogs (80%) were re-evaluated, and all exhibited persistent adhesions. The owners of the eight dogs that missed the 6-month ultrasound check were contacted by telephone to gather follow-up information. None of these dogs exhibited any signs suggestive of GDV or other postoperative complications, further supporting the short-term efficacy
References
[1]
de Battisti, A., Toscano, M.J. and Formaggini, L. (2012) Gastric Foreign Body as a Risk Factor for Gastric Dilatation and Volvulus in Dogs. JournaloftheAmericanVeterinaryMedicalAssociation, 241, 1190-1193. https://doi.org/10.2460/javma.241.9.1190
[2]
Pipan, M., Brown, D.C., Battaglia, C.L. and Otto, C.M. (2012) An Internet-Based Survey of Risk Factors for Surgical Gastric Dilatation-Volvulus in Dogs. JournaloftheAmericanVeterinaryMedicalAssociation, 240, 1456-1462. https://doi.org/10.2460/javma.240.12.1456
[3]
Bell, J.S. (2014) Inherited and Predisposing Factors in the Development of Gastric Dilatation Volvulus in Dogs. TopicsinCompanionAnimalMedicine, 29, 60-63. https://doi.org/10.1053/j.tcam.2014.09.002
[4]
Sharp, C.R. and Rozanski, E.A. (2014) Cardiovascular and Systemic Effects of Gastric Dilatation and Volvulus in Dogs. TopicsinCompanionAnimalMedicine, 29, 67-70. https://doi.org/10.1053/j.tcam.2014.09.007
[5]
Uhrikova, I., Machackova, K., Rauserova-Lexmaulova, L., Janova, E. and Doubek, J. (2015) Risk Factors for Gastric Dilatation and Volvulus in Central Europe: An Internet Survey. Veterinárnímedicína, 60, 578-587. https://doi.org/10.17221/8496-vetmed
[6]
O’Neill, D.G., Case, J.B., Boag, A.K., Church, D.B. and McGreevy, P.D. (2017) Gastric Dilation-Volvulus in Dogs Attending UK Emergency-Care Veterinary Practices: Prevalence, Risk Factors and Survival. Journal of Small Animimal Practice, 58, 629-638.
[7]
Cornell, K. (2018) Stomach: Specific Disease: Gastric Dilatation Volvulus. In: John-ston, S.A. and Tobias, K.M., Eds., VeterinarySurgery: SmallAnimal, Elsevier, 1726-1730.
[8]
Ward, M.P., Patronek, G.J. and Glickman, L.T. (2003) Benefits of Prophylactic Gastropexy for Dogs at Risk of Gastric Dilatation–volvulus. PreventiveVeterinaryMedicine, 60, 319-329. https://doi.org/10.1016/s0167-5877(03)00142-9
[9]
Loy Son, N.K., Singh, A., Amsellem, P., Kilkenny, J., Brisson, B.A., Oblak, M.L., et al. (2016) Long‐Term Outcome and Complications Following Prophylactic Laparoscopic‐assisted Gastropexy in Dogs. VeterinarySurgery, 45, O77-O83. https://doi.org/10.1111/vsu.12568
[10]
Mayhew, P.D. and Brown, D.C. (2009) Prospective Evaluation of Two Intracorporeally Sutured Prophylactic Laparoscopic Gastropexy Techniques Compared with Laparoscopic‐Assisted Gastropexy in Dogs. VeterinarySurgery, 38, 738-746. https://doi.org/10.1111/j.1532-950x.2009.00554.x
[11]
Mathon, D.H., Dossin, O., Palierne, S., Cremoux, M., Rodriguez, H., Meynaud‐Collard, P., et al. (2009) A Laparoscopic‐Sutured Gastropexy Technique in Dogs: Mechanical and Functional Evaluation. VeterinarySurgery, 38, 967-974. https://doi.org/10.1111/j.1532-950x.2009.00592.x
[12]
Spah, C.E., Elkins, A.D., Wehrenberg, A., Jaffe, M.H., Baird, D.K., Naughton, J.F., et al. (2013) Evaluation of Two Novel Self‐Anchoring Barbed Sutures in a Prophylactic Laparoscopic Gastropexy Compared with Intracorporeal Tied Knots. VeterinarySurgery, 42, 932-942. https://doi.org/10.1111/j.1532-950x.2013.12043.x
[13]
Imhoff, D.J., Cohen, A. and Monnet, E. (2014) Biomechanical Analysis of Laparoscopic Incisional Gastropexy with Intracorporeal Suturing Using Knotless Polyglyconate. VeterinarySurgery, 44, 39-43. https://doi.org/10.1111/j.1532-950x.2014.12177.x
[14]
Takacs, J.D., Singh, A., Case, J.B., Mayhew, P.D., Giuffrida, M.A., Caceres, A.V., et al. (2016) Total Laparoscopic Gastropexy Using 1 Simple Continuous Barbed Suture Line in 63 Dogs. VeterinarySurgery, 46, 233-241. https://doi.org/10.1111/vsu.12601
[15]
Stiles, M., Case, J.B. and Coisman, J. (2016) Elective Gastropexy with a Reusable Single-Incision Laparoscopic Surgery Port in Dogs: 14 Cases (2012-2013). JournaloftheAmericanVeterinaryMedicalAssociation, 249, 299-303. https://doi.org/10.2460/javma.249.3.299
[16]
Coleman, K.A. and Monnet, E. (2017) Comparison of Laparoscopic Gastropexy Performed via Intracorporeal Suturing with Knotless Unidirectional Barbed Suture Using a Needle Driver versus a Roticulated Endoscopic Suturing Device: 30 Cases. VeterinarySurgery, 46, 1002-1007. https://doi.org/10.1111/vsu.12722
[17]
Deroy, C., Hahn, H., Bismuth, C., Ragetly, G., Gomes, E. and Poncet, C. (2019) Simplified Minimally Invasive Surgical Approach for Prophylactic Laparoscopic Gastropexy in 21 Cases. JournaloftheAmericanAnimalHospitalAssociation, 55, 152-159. https://doi.org/10.5326/jaaha-ms-6879
[18]
Giaconella, V., Grillo, R., Giaconella, R., Properzi, R. and Gialletti, R. (2021) Outcomes and Complications in a Case Series of 39 Total Laparoscopic Prophylactic Gastropexies Using a Modified Technique. Animals, 11, Article 255. https://doi.org/10.3390/ani11020255
[19]
Lacitignola, L., Fracassi, L., Di Bella, C., Zizzo, N., Passantino, G., Tinelli, A., et al. (2020) Absorbable Fixation Straps for Laparoscopic Gastropexy in Dogs. VeterinarySurgery, 50, O78-O88. https://doi.org/10.1111/vsu.13543
[20]
Rawlings, C.A., Foutz, T.L., Mahaffey, M.B., Howerth, E.W., Bement, S. and Canalis, C. (2001) A Rapid and Strong Laparoscopic-Assisted Gastropexy in Dogs. AmericanJournalofVeterinaryResearch, 62, 871-875. https://doi.org/10.2460/ajvr.2001.62.871
[21]
Wacker, C.A., Weber, U.T., Tanno, F. and Lang, J. (1998) Ultrasonographic Evaluation of Adhesions Induced by Incisional Gastropexy in 16 Dogs. JournalofSmallAnimalPractice, 39, 379-384. https://doi.org/10.1111/j.1748-5827.1998.tb03736.x
[22]
Tanno, F., Weber, U., Wacker, C., Gaschen, L., Schmid, V. and Lang, J. (1998) Ultrasonographic Comparison of Adhesions Induced by Two Different Methods of Gastropexy in the Dog. JournalofSmallAnimalPractice, 39, 432-436. https://doi.org/10.1111/j.1748-5827.1998.tb03751.x
[23]
Baron, J.K., Casale, S.A., Monnet, E., Mayhew, P.D., Runge, J.J., Follette, C.M., et al. (2019) Paramedian Incisional Complications after Prophylactic Laparoscopy‐Assisted Gastropexy in 411 Dogs. VeterinarySurgery, 49, 1465-1468. https://doi.org/10.1111/vsu.13348
[24]
Tomlinson, A.W., Lillis, S.M., German, A.J. and Burrow, R.D. (2016) Pyloric Localisation in 57 Dogs of Breeds Susceptible to Gastric Dilatation‐Volvulus Using Computed Tomography. VeterinaryRecord, 179, 626-626. https://doi.org/10.1136/vr.103853
[25]
Whitney, W.O. (1998) Belt Loop Gastropexy. In: Joseph Bojrab, M., Ed., CurrentTechniques inSmallAnimalSurgery, 4th Edition, William & Wilkins, 238-241.