Canis ISSN: 2398-2942

Gastric dilatation / volvulus: surgical repair

Synonym(s): GDV, gastric torsion

Contributor(s): Andrew Gardiner, Zoe Halfacree, Lori Ludwig

Introduction

Therapeutic objectives
  • Visual assessment of the stomach and spleen to determine or confirm the presence of a gastric rotation Stomach: gastric dilatation / volvulus (GDV) syndrome.
    Almost all cases have a clockwise rotation when viewed intra-operatively.
  • Decompression of the stomach if required.
    Decompression should be initiated during the important pre-operative stabilization phase of management of this condition. Additional decompression may however be required during surgery.
  • Derotation of the stomach and resection (stomach, spleen) of devitalized tissues.
  • Generalized inspection of the abdominal cavity for additional complications of gastric dilatation and volvulus, eg hemoabdomen following rupture of the short gastric vessels and ischemic necrosis of other organs in severe cases.
Prophylactic objective
  • Anchorage (gastropexy) of the stomach (pyloric antrum to the right body wall) in order to prevent future occurrences of gastric torsion.

Uses

  • Definitive treatment and prophylaxis of the stabilized GDV patient.

Surgical options for gastropexy

  • Incisional gastropexy - this technique is quick and easy to perform.
  • 'Belt-loop' gastropexy Gastropexy: belt loop is straightforward to perform. It is simpler than the circumcostal technique and produces a robust anchorage for the stomach.
  • Tube gastropexy/gastrostomy Gastrostomy: percutaneous tube 2 (pipe introducer) - this technique is useful because it allows post-operative decompression of the stomach and delivery of nutrition, should this be necessary. It is rapid to perform. The mushroom tipped DePezzer catheter must be leftin situfor 7-10 days to allow adequate adhesions to develop. In contrast to tube gastrostomy Gastrostomy: percutaneous tube 1 (endoscopic) Gastrostomy: percutaneous tube 2 (pipe introducer) performed specifically for nutrition, the tube gastrostomy must be performed from the pyloric antrum to the right body wall to stabilize the pylorus.
  • Circumcostal gastropexy- this produces a robust pexy but is more complicated to perform Circumcostal gastropexy 01 Circumcostal gastropexy 02 Circumcostal gastropexy 03 ; pneumothorax Pneumothorax can occur as a complication.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Even with vigorous therapy and monitoring the prognosis for GDV is guarded. A mortality rate of c. 40% has been reported.
  • Mortality rate for dogs with GDV has recently been reported to be 15%.
  • Dogs with gastric necrosis have a worse prognosis, ~30% mortality rate.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Parton A T, Volk S W & Weisse C (2006) Gastric ulceration subsequent to partial invagination of the stomach in a dog with gastric dilatation-volvulus. JAVMA 228 (12), 1895-1900 PubMed.
  • Clickman L T, Lantz G C, Schellenbert D B et al (1998) A prospective study of survival and recurrence following the acute gastric dilatation - volvulus syndrome in 136 dogs. JAAHA 34 (3), 253-259 PubMed.
  • Tanno F, Weber U, Wacker C H et al (1998) Ultrasonographic comparison of adhesions induced by two different methods of gastropexy in the dog. JSAP 39 (9), 432-436 PubMed.
  • Brockmann D J, Washabau R J & Drobatz K J (1995) Canine gastric dilatation/volvulus syndrome in a veterinary critical care unit - 295 cases (1986-1992). JAVMA 207 (4), 460-464 PubMed.
  • Lindgren W G et al (1995) Long-term follow-up and clinical results of incisional gastropexy for repair of GDV syndrome. Vet Surg 24, 430.
  • Ellison G W (1993) Gastric dilatation volvulus - surgical prevention. Vet Clin North Am Small Anim Pract 23 (3), 513-530 PubMed.
  • Meyer-Lindenberg A, Hardner A, Fehr M (1993) Treatment of gastric dilatation-volvulus and a rapid method for prevention of relapse in dogs - 134 cases (1988-1991). JAVMA 203 (9), 1303-1307 VetMedResource.
  • Whitney W D, Scavelli T D, Matthiesen D T et al (1989) Belt-loop gastropexy - technique and surgical result in 20 dogs. JAHHA 25 (1), 75-83 VetMedResource.

Other sources of information


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