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Open & Laparoscopic-Assisted Incisional Gastropexy

W. Alexander Fox-Alvarez, DVM, University of Florida

J. Brad Case, DVM, MS, DACVS, University of Florida

Surgery, Soft Tissue

|May 2015|Peer Reviewed

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Gastric dilatation–volvulus (GDV) is a life-threatening medical and surgical emergency. The acute medical crisis is brought on by massive gastric distension, which compresses critical vasculature, causing gastric ischemia, impaired venous return, and poor cardiac output. This leads to hypovolemic shock, myocardial ischemia, cardiac arrhythmia, electrolyte imbalance, visceral necrosis, and other detrimental effects.

Related Article: Belt-Loop Gastropexy for Gastric Dilatation Volvulus 

Large- and giant-breed dogs, underweight dogs, and dogs with a large thoracic depth:width ratio are at greater risk for developing GDV. This risk increases with age. One study found large and giant purebred dogs to have a lifelong risk for developing GDV of 24% and 21.6%, respectively.1

What Is a Gastropexy?

Gastropexy is a surgical procedure that creates a permanent adhesion between the pyloric antrum and the right abdominal wall, preventing gastric volvulus. When used to treat patients with GDV, recurrence rates drop to less than 5% compared with more than 50% if no gastropexy is performed.2 In a recent study, at-risk dogs treated with prophylactic incisional gastropexy had no episodes of GDV after a mean follow-up time of 2 years—results that are the same as or better than those for other reported techniques.3

Several gastropexy techniques have been described, including incisional, belt-loop, circumcostal, tube, incorporating, gastrocolopexy, endoscopically assisted, laparoscopic-assisted, and laparoscopic gastropexy.4 The minimally invasive procedures employ an incisional gastropexy in their technique. The authors prefer the incisional gastropexy technique because it is relatively safe, effective, and technically simple to perform.3 Prophylactic gastropexy can be performed alone or at the same time as sterilization in at-risk breeds. This article serves as a reference for performing incisional gastropexy using both open and laparoscopic-assisted5 techniques.

Related Article: Surgeon's Corner: Surgical Management of Gastric Dilatation-Volvulus (GDV) 

Patient Positioning

For both open and laparoscopic-assisted incisional gastropexy, the patient should be positioned in dorsal recumbency and the abdomen prepared using standard aseptic technique.

What You Will Need

For Open Incisional Gastropexy

  • Standard surgical pack
  • 2-0 polydioxanone suture (PDS) or other monofilament absorbable suture of choice

Clinician's Brief

What You Will Need

Clinician's Brief

For Laparoscopic-Assisted Incisional Gastropexy 

  • Standard surgical pack
  • 2-0 PDS or other monofilament absorbable suture of choice
  • #11 blade
  • Video laparoscopy tower (A) with camera (B), insufflation tubing (C), light cable (D), and video capture device 10-mm laparoscopic Babcock forceps (E)
  • 5-mm laparoscope 0° (F)
  • 5-mm trocar (G) and 10-mm trocar (H)
  • Clinician's Brief

    References

    For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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