Post-surgical photobiomodulation therapy improves outcomes following elective gastropexy in dogs.

PURPOSE: To evaluate the effect of post-surgical photobiomodulation therapy in dogs. METHODS: Twenty dogs were selected for elective gastropexy and randomly divided into a control (CG, n = 10) and a PBMT group (PBMTG, n = 10). Pre­medication consisted of medetomidine and butorphanol. Meloxicam was administered before the procedure. Induction was performed with propofol and maintained with sevoflurane. Local blocks with lidocaine were used. Incisional gastropexy was performed in all animals. PBMTG received PBMT immediately after surgery. The need for postoperative rescue analgesia, if the animal had eaten by the evaluation momen, and pain scores were collected using the Glasgow Composite Measure Pain Scale - Short Form (CMPS­SF) at 1, 2, 4, 6, 8, 12, 16, 20, and 24 h post­endotracheal extubation. CMPS­SF scores were compared with the Mann-Whitney Test and proportions of animals that required rescue analgesia and had eaten with a χ2 test. P was set at < 0.05. RESULTS: No rescue analgesia was needed for any animal. Still, significant differences were observed in CMPS-SF scores between CG and PBMTG between 1 and 4 h post-extubation. PBMTG had a significantly higher proportion of animals eating up to the 8 h post-extubation evaluation moment. CONCLUSION: Adding post-surgical photobiomodulation to a standard anesthesia and analgesia protocol reduced CMPS-SF scores and increased the proportion of animals that resumed eating compared to the standard protocol alone.

Effect of preoperative ondansetron on postoperative nausea in healthy dogs undergoing laparoscopic gastropexy and castration.

OBJECTIVE: To investigate if preoperative ondansetron reduces postoperative nausea associated with laparoscopic gastropexy and castration in dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Twenty client-owned, healthy male dogs. METHODS: Dogs were premedicated with dexmedetomidine (2-5 mcg kg-1) and methadone (0.2-0.5 mg kg-1) intramuscularly. General anesthesia was induced with propofol and maintained with an inhalant anesthetic agent. Dogs were randomized into group S (saline 0.1 mL kg-1, intravenously) or group O (ondansetron 0.2 mg kg-1, intravenously). Plasma and serum were collected before premedication and 3 hours postextubation to measure arginine vasopressin (AVP) and cortisol concentrations. Nausea scoring occurred before and 10 minutes after premedication, immediately after extubation, and at 1, 2 and 3 hours postextubation. Data were analyzed by mixed and split-plot anova with Bonferroni adjustment for the number of group comparisons. Significance was set at p < 0.05. RESULTS: Nausea scores increased over time at 1 (p = 0.01) and 2 (p < 0.001) hours postextubation in both groups compared with before premedication. Median nausea score (0-100 mm) for groups S and O before premedication were 2.5 and 0.5 mm, respectively. At 1 and 2 hours postextubation, group S scored 7.5 and 4.0 mm and group O scored 6.0 and 5.0 mm, respectively. No significant differences in nausea scores within or between groups were observed before premedication and 3 hours postextubation. Cortisol concentrations increased significantly 3 hours postextubation in both groups (p < 0.001) compared with before premedication, with no differences between groups. AVP concentrations showed no significant differences within or between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Preoperative intravenous administration of ondansetron (0.2 mg kg-1) did not impact postoperative nausea after laparoscopic gastropexy and castration. Investigation of higher doses of ondansetron on the incidence of postoperative nausea and vomiting in dogs after surgery is warranted.

Bilious abdomen development in a dog following prophylactic incisional gastropexy and a hollow viscus distension event.

Bilious abdomen is an uncommon but life-threatening condition that has not previously been associated with prophylactic gastropexy. In animals, bilious abdomen is associated with a high mortality rate, due in large part to resulting bile peritonitis. Most bilious abdomen cases in veterinary medicine occur secondary to underlying gallbladder disease or blunt abdominal trauma. This case report describes an instance of atraumatic bilious abdomen with no evidence of primary hepatobiliary disease. Prophylactic incisional gastropexy was performed on a dog within 72 h of its developing bilious abdomen. It is possible that undergoing a gastropexy increased tension on the common bile duct, but no known direct surgical trauma to the duct occurred. The cause of bile leakage in this case is suspected to be secondary to trauma from a distended hollow viscus. Findings at the time of the second surgery support this conclusion. Key clinical message: This case suggests a novel mechanism for the development of bilious abdomen in dogs.

Développement d'un abdomen bilieux chez un chien après une gastropexie incisionnelle prophylactique et un événement de distension des viscères creux. L'abdomen bilieux est une affection rare mais potentiellement mortelle qui n'a jamais été associée à une gastropexie prophylactique. Chez les animaux, l'abdomen bilieux est associé à un taux de mortalité élevé, dû en grande partie à la péritonite biliaire qui en résulte. La plupart des cas d'abdomen bilieux en médecine vétérinaire sont secondaires à une maladie sous-jacente de la vésicule biliaire ou à un traumatisme contondant abdominal. Ce rapport de cas décrit un cas d'abdomen bilieux atraumatique sans signe de maladie hépatobiliaire primaire. Une gastropexie incisionnelle prophylactique a été réalisée sur un chien dans les 72 heures précédant le développement de son abdomen bilieux. Il est possible que la gastropexie ait augmenté la tension sur le canal biliaire principal, mais aucun traumatisme chirurgical direct connu du canal ne s'est produit. La cause de la fuite biliaire dans ce cas est soupçonnée d'être secondaire à un traumatisme causé par un viscère creux distendu. Les résultats de la deuxième intervention chirurgicale confortent cette conclusion.Message clinique clé :Ce cas suggère un nouveau mécanisme pour le développement de l'abdomen bilieux chez le chien.(Traduit par Dr Serge Messier).

Perioperative characteristics and long-term outcomes following prophylactic total laparoscopic gastropexy using a novel knotless tissue control device in 44 dogs.

Objective: To report on operative technique and outcomes following prophylactic total laparoscopic gastropexy (PTLG) using a novel knotless tissue control device (KTCD) in dogs. Animals: This study included 44 dogs. Procedure: Medical records were reviewed, and perioperative data were collected. Right-sided incisional gastropexy was performed using 2 strands of KTCD introduced through a 12-millimeter cannula in a single-incision multi-channeled port. Dog owners were contacted to obtain outcome data. Results: Median age and weight of dogs were 17 mo (6 to 60 mo) and 48.5 kg (14 to 73.3 kg). Median surgical and anesthesia times were 90 min (60 to 150 min) and 195 min (135 to 270 min). Major intraoperative complications were not reported. Follow-up data were available for 40/44 (91%) dogs. Median follow-up time was 522 d (43 to 983 d). Gastric dilatation volvulus (GDV) was not reported in any dog. One dog developed suspected colonic entrapment around the gastropexy that required surgical revision. All owners were satisfied with the procedure and indicated they would repeat the procedure with future pets. Conclusion: The PTLG procedure using novel KTCD in this cohort of dogs was effective at preventing GDV for the duration of follow-up and was associated with low perioperative complication rate and high owner satisfaction. Clinical relevance: This retrospective study reports on operative technique and outcomes associated with KTCD use in PTLG. Our findings warrant prospective evaluation of KTCD use in PTLG.

Caractéristiques peropératoires et résultats à long terme après une gastropexie laparoscopique totale prophylactique à l'aide d'un nouveau dispositif de contrôle des tissus sans nœuds chez 44 chiens. Objectif: Rendre compte de la technique opératoire et des résultats après une gastropexie laparoscopique totale prophylactique (PTLG) à l'aide d'un nouveau dispositif de contrôle des tissus sans nœuds (KTCD) chez le chien. Animaux: Cette étude a inclus 44 chiens. Procédure: Les dossiers médicaux ont été examinés et les données peropératoires ont été recueillies. La gastropexie incisionnelle du côté droit a été réalisée à l'aide de 2 brins de KTCD introduits par une canule de 12 millimètres dans un orifice multicanal à incision unique. Les propriétaires de chiens ont été contactés pour obtenir des données sur les résultats. Résultats: L'âge et le poids médians des chiens étaient de 17 mois (6 à 60 mois) et 48,5 kg (14 à 73,3 kg). Les temps chirurgicaux et anesthésiques médians étaient de 90 min (60 à 150 min) et 195 min (135 à 270 min). Des complications peropératoires majeures n'ont pas été rapportées. Des données de suivi étaient disponibles pour 40/44 (91 %) chiens. La durée médiane de suivi était de 522 jours (43 à 983 jours). Le volvulus de dilatation gastrique (GDV) n'a été signalé chez aucun chien. Un chien a développé une suspicion de piégeage du côlon autour de la gastropexie qui a nécessité une reprise chirurgicale. Tous les propriétaires étaient satisfaits de la procédure et ont indiqué qu'ils répéteraient la procédure avec de futurs animaux de compagnie. Conclusion: La procédure PTLG utilisant le nouveau KTCD dans cette cohorte de chiens a été efficace pour prévenir le GDV pendant la durée du suivi et a été associée à un faible taux de complications peropératoires et à une satisfaction élevée des propriétaires. Pertinence clinique: Cette étude rétrospective rend compte de la technique opératoire et des résultats associés à l'utilisation de KTCD dans le PTLG. Nos résultats justifient une évaluation prospective de l'utilisation de KTCD dans le PTLG.(Traduit par Dr Serge Messier).

Counterclockwise gastric dilatation and volvulus in a dog.

A 6-year-old neutered male golden retriever mix dog was presented for investigation of acute restlessness, increased respiratory effort, non-productive retching, and anorexia. Initial abdominal radiography revealed marked gastric dilation with a normal gastric shape and position, along with mineralized granular material in the pyloric region, consistent with a pyloric outflow obstruction secondary to suspected sand impaction. The dog was stabilized with gastric trocharization and medical management with intravenous fluids, antiemetics, polyethylene glycol via a nasogastric tube, and analgesia was initiated. The dog developed aspiration pneumonia during hospitalization and became oxygen-dependent. There was no significant improvement of clinical status despite 72 h of medical management, and surgical intervention was subsequently recommended. Exploratory laparotomy revealed a counterclockwise gastric dilatation and volvulus. The stomach was repositioned into normal anatomic position and an incisional gastropexy was performed. The dog was maintained in the intensive care unit for 4 d postoperatively. Currently, 3 mo postoperatively, the dog is healthy without recurrence of clinical signs. Key clinical message: Counterclockwise gastric dilatation and volvulus is a rare condition in veterinary medicine; however, it should be considered in a patient with acute gastric distension and signs of pyloric outflow obstruction when characteristic radiological signs of clockwise gastric dilatation and volvulus are absent, and there is radiological evidence of persistent gastric foreign material despite medical management. Misdiagnosis of counterclockwise gastric dilatation and volvulus can delay definitive surgical intervention and lead to higher morbidity and mortality.

Dilatation gastrique dans le sens inverse des aiguilles d'une montre et volvulus chez un chien. Un chien golden retriever mâle castré âgé de 6 ans a été présenté pour évaluation à la suite d'agitation aiguë, d'un effort respiratoire accru, des haut-le-coeur non productifs et d'anorexie. La radiographie abdominale initiale a révélé une dilatation gastrique marquée avec une forme et une position gastrique normales, ainsi qu'un matériau granulaire minéralisé dans la région pylorique, compatible avec une suspicion d'obstruction de l'écoulement pylorique secondaire à une impaction par du sable. Le chien a été stabilisé avec une trocarisation gastrique et une prise en charge médicale avec des fluides intraveineux, des antiémétiques, du polyéthylène glycol via une sonde nasogastrique, et une analgésie a été initiée. Le chien a développé une pneumonie par aspiration pendant l'hospitalisation et est devenu dépendant de l'oxygène. Il n'y a pas eu d'amélioration significative de l'état clinique malgré 72 h de prise en charge médicale et une intervention chirurgicale a été recommandée. La laparotomie exploratrice a révélé une dilatation gastrique dans le sens inverse des aiguilles d'une montre et un volvulus. L'estomac a été repositionné en position anatomique normale et une gastropexie incisionnelle a été réalisée. Le chien a été maintenu en unité de soins intensifs pendant 4 jours après l'opération. Actuellement, 3 mois après l'opération, le chien est en bonne santé sans récidive des signes cliniques.Message clinique clé :La dilatation dans le sens inverse des aiguilles d'une montre et le volvulus gastriques sont une affection rare en médecine vétérinaire; cependant, cela doit être envisagé chez un patient présentant une distension gastrique aiguë et des signes d'obstruction de l'écoulement pylorique en l'absence de signes radiologiques caractéristiques de dilatation gastrique dans le sens des aiguilles d'une montre et de volvulus, et en cas de preuve radiologique de corps étranger gastrique persistant malgré la prise en charge médicale. Un diagnostic erroné de dilatation gastrique dans le sens inverse des aiguilles d'une montre et de volvulus peut retarder l'intervention chirurgicale définitive et entraîner une morbidité et une mortalité plus élevées.(Traduit par Dr Serge Messier).

Absorbable fixation straps for laparoscopic gastropexy in dogs.

OBJECTIVE: To evaluate the feasibility and efficacy of laparoscopic absorbable fixation straps (AFS) for laparoscopic gastropexy in dogs. STUDY DESIGN: Cadaveric and prospective clinical study. ANIMALS: Five dog cadavers for the cadaveric study; 12 dogs for the clinical study. METHODS: The pyloric antrum was affixed to the abdominal wall laparoscopically by applying a series of straps. The cadaveric study assessed potential challenges during the procedure and stomach mucosal penetration. For the clinical study, the total duration of surgery, time to complete the gastropexy, and the number of straps used were recorded. Ultrasound evidence of adhesion, complications, and weight were monitored at 7, 30, and 90 days after surgery. Owner satisfaction was evaluated at the 6-month follow-up. RESULTS: The total duration of surgery was 25.8 minutes (range, 19-39; SD, 6.7), and the time to complete the gastropexy was 10.1 minutes (range, 7-19; SD, 3.9). The linear regression analysis revealed an inverse correlation between the time to complete the gastropexy and the order of the surgeries (r2  = 0.75, P < .05). No complications were recorded. Ultrasound examination was used to confirm gastropexy at all follow-ups. CONCLUSION: Laparoscopic gastropexy with AFS was performed in both cadavers and clinical animals with minimal complications. Persistent adhesion was demonstrated during ultrasound evaluations and in one postmortem evaluation. CLINICAL SIGNIFICANCE: This novel laparoscopic technique can be employed safely, effectively, and reasonably quickly, and the learning curve is expected to be relatively short.

A randomized controlled trial of three-dimensional versus two-dimensional imaging system on duration of surgery and mental workload for laparoscopic gastropexies in dogs.

OBJECTIVE: To evaluate the effect of three-dimensional (3D) laparoscopy compared to two-dimensional (2D) laparoscopy when evaluating duration of surgery for canine intracorporeally sutured gastropexy. STUDY DESIGN: Randomized controlled clinical trial. ANIMALS: Thirty client-owned dogs. METHODS: Dogs were randomized into 2D or 3D groups and underwent a three-port laparoscopic intracorporeally sutured incisional gastropexy with barbed suture. Procedures were performed by a single board-certified surgeon. Duration of surgery was recorded and workload was assessed immediately after surgery using the NASA Task Load Index (TLX). RESULTS: Median duration of surgery was 3 min shorter for 3D versus 2D (95%CI -10 to 13; p = .51). Surgical component durations, total and component TLX scores, and intraoperative complications also did not differ between groups. In a subgroup analysis excluding the first eight cases due to presumption of a learning curve with suturing technique, total TLX score (p = .004) and all component scores were lower for 3D as compared to 2D laparoscopy, although duration of surgery did not differ (p = .20). CONCLUSION: The use of 3D laparoscopy was not associated with shorter duration of surgery when compared to 2D laparoscopy. CLINICAL SIGNIFICANCE: 3D laparoscopy requires further investigation in veterinary medicine to determine its utility in decreasing surgical duration, surgical complications or surgeon mental or physical workload.

Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy utilizing a 2-port technique in 10 dogs.

A case series was selected retrospectively to evaluate the technique, outcome, and short-term complications associated with a combined laparoscopic ovariectomy (Lap OVX) and laparoscopic-assisted gastropexy (LAG) using a 2-port technique, and to compare it with previously published combined laparoscopic techniques for Lap OVX and LAG in dogs. Medical records of dogs undergoing elective, combined Lap OVX and LAG performed using a 2-port technique between 2017 and 2019 were reviewed. Total surgical time was compared to previously published combined Lap OVX and LAG techniques in dogs. Intraoperative and short-term complications were recorded. Ten dogs [median weight: 29.4 kg (range: 11.4 to 84.1 kg); mean: 37.4] met the inclusion criteria. Median surgical time to complete both the Lap OVX and LAG was 72.5 minutes (range: 47.0 to 120.0 minutes; mean: 77.4 minutes), which was not significantly different than that described in previous studies of combined Lap OVX and LAG (weighted mean average: 67.3 minutes; 95% confidence interval: 46.9 to 87.7, P = 0.3). No intraoperative or postoperative complications were reported. It is concluded that a 2-port technique for combined Lap OVX and LAG is feasible, has few complications, and requires similar time to perform compared to other previously published laparoscopic techniques.

Ovariectomie laparoscopique combinée à une gastropexie assistée par laparoscopie en utilisant une technique à deux orifices chez 10 chiens. Une série de cas a été sélectionnée rétrospectivement pour évaluer la technique, les résultats et les complications à court terme associées à une ovariectomie laparoscopique (Lap OVX) combinée à une gastropexie assistée par laparoscopie (LAG) en utilisant une technique à deux orifices, et pour la comparer avec les publications précédentes de techniques laparoscopiques combinées pour Lap OVX et LAG chez le chien. Les dossiers médicaux des chiens soumis à une Lap OVX et une LAG électives combinées effectuées à l'aide d'une technique à deux orifices entre 2017 et 2019 ont été examinés. Le temps chirurgical total a été comparé aux techniques combinées Lap OVX et LAG précédemment publiées chez le chien. Les complications peropératoires et à court terme ont été enregistrées. Dix chiens [poids médian : 29,4 kg (intervalle : 11,4 à 84,1 kg), moyenne : 37,4] répondaient aux critères d'inclusion. Le temps chirurgical médian pour terminer à la fois la Lap OVX et la LAG était de 72,5 minutes (intervalle : 47,0 à 120,0 minutes; moyenne : 77,4 minutes), ce qui n'était pas significativement différent de celui décrit dans les études précédentes sur l'association Lap OVX et LAG (moyenne pondérée moyenne : 67,3 minutes, intervalle de confiance à 95 % : 46,9 à 87,7, P = 0,3). Aucune complication peropératoire ou postopératoire n'a été rapportée. Il est conclu qu'une technique à deux orifices pour la combinaison Lap OVX et LAG est réalisable, comporte peu de complications et nécessite un temps d'exécution similaire à celui d'autres techniques laparoscopiques précédemment publiées.(Traduit par Dr Serge Messier).

Soft tissue sarcoma at the site of a previous laparoscopic-assisted gastropexy in a dog.

An 8-year-old, spayed female, Doberman pinscher dog was presented to the Ontario Veterinary College Health Sciences Center for evaluation of a large subcutaneous mass on the right cranial ventral abdomen. Computed tomography localized a 6 × 7 cm soft tissue mass to the site of a laparoscopic-assisted gastropexy performed 3 years earlier. Body wall resection with wide surgical margins was performed. Histological evaluation identified the mass as a grade III soft tissue sarcoma with clean surgical margins. To the authors' knowledge, this report is the first to detail a case of a soft tissue sarcoma that is suspected to have originated at and/or infiltrated into tissues that were previously incised during a surgical procedure. Key clinical message: Based on this case, there is a possibility of a clinical correlate to the feline injection site sarcoma in the canine species.

Sarcome des tissus mous au site d'une gastropexie aidée par laparoscopie antérieure chez un chien. Une chienne Doberman pinscher stérilisée âgée de 8 ans fut présentée au Health Sciences Center de l'Ontario Veterinary College pour évaluation d'une large masse sous-cutanée au niveau de l'abdomen ventral crânial droit. Une tomodensitométrie permis de localiser une masse de tissus mous de 6 × 7 cm au site d'une gastropexie aidée par laparoscopie effectuée 3 ans plus tôt. Une résection de la paroi corporelle avec de larges bordures chirurgicales fut réalisée. Une évaluation histologique identifia la masse comme étant un sarcome des tissus mous de grade III avec des bordures chirurgicales nettes. À la connaissance des auteurs ce rapport est le premier à détailler un cas de sarcome des tissus mous qui est suspecté avoir son origine et/ou avoir infiltré des tissus qui furent précédemment incisés durant une procédure chirurgicale.Message clinique clé:Sur la base de ce cas, il y a possibilité d'une relation clinique avec le sarcome du site d'injection chez le chat chez l'espèce canine.(Traduit par Dr Serge Messier).

Paramedian incisional complications after prophylactic laparoscopy-assisted gastropexy in 411 dogs.

OBJECTIVE: To determine the frequency and types of paramedian incisional complications after prophylactic laparoscopy-assisted gastropexy (LAG) in dogs and to evaluate potential risk factors for complications. STUDY DESIGN: Multi-institutional retrospective study. ANIMALS: Client-owned dogs (N = 411). METHODS: Records for dogs that underwent single-incision-port laparoscopy-assisted gastropexy (SIPLAG) or multiple-port laparoscopy-assisted gastropexy (MPLAG) at five veterinary referral hospitals were reviewed. Information regarding signalment, surgical procedures, perioperative care, and incisional complications was collected. Follow-up information was obtained by review of medical records and/or communication with owners. Potential risk factors for complications were examined statistically. RESULTS: Paramedian incisional complications were observed in 78 of 411 (19%) dogs. The most common complication was seroma formation, which occurred in 51 (12.4%) dogs. Surgical site infections were observed in 16 (3.9%) dogs, and dehiscence or development of excessive scar tissue at the incision site were each observed in nine (2.2%) dogs. Complications resolved with conservative treatment in 75 of 78 (96.2%) dogs and with surgical treatment in three of 78 (3.8%) dogs. The odds of complications were approximately twice as high in dogs undergoing SIPLAG than in dogs undergoing MPLAG (odds ratio, 2.03; P = .006). CONCLUSION: Minor paramedian incisional complications, particularly seroma formation, were frequently observed after LAG. Most complications were successfully managed conservatively. Single-incision-port laparoscopy-assisted gastropexy was associated with a higher complication rate compared with MPLAG. CLINICAL SIGNIFICANCE: Owners should be informed that there is a relatively high rate of minor paramedian incisional complications after LAG. The risk of complications appears to be higher for SIPLAG than for MPLAG.

Influence of length of incision and number of suture lines on the biomechanical properties of incisional gastropexy.

OBJECTIVE: To determine the effect of the length of incision and of the number of suture lines on the load to failure of incisional gastropexy in an ex vivo model. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Thirty-six hound-mix fresh canine cadavers. METHODS: Specimens were randomly divided into four groups of incisional gastropexies varying in length of incision (2 or 4 cm) and number of suture lines (one or two). Load to failure was measured. Number of suture bites on each side of the gastropexy and number of inadvertent full thickness gastric suture bites were recorded. RESULTS: Incisional gastropexies performed with one or two suture lines sustained loads to failure of 53.80 ± 12.10 N and 53.30 ± 10.60 N (P = .887), respectively. Loads to failure equal to 49.70 ± 10.80 N and 57.30 ± 10.60 N (P = .048) were measured on incisional gastropexies performed with 2- or 4-cm-suture lines, respectively. There was no interaction between the length of the incision and the number of suture lines (P = .634). CONCLUSION: Length of incision but not number of suture lines influenced the biomechanical properties of gastropexies in this acute cadaveric model. CLINICAL SIGNIFICANCE: According to this acute in vitro experiment, gastropexy can be performed with either one or two suture lines.

Meloxicam vs robenacoxib for postoperative pain management in dogs undergoing combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy.

OBJECTIVE: To compare meloxicam and robenacoxib for short-term postoperative pain management after combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy. STUDY DESIGN: Double-blind, prospective, randomised clinical trial. ANIMALS: Twenty-six client-owned female dogs. METHODS: Dogs undergoing combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy were randomly divided into 2 groups. Before induction of anesthesia, 13 dogs received meloxicam (0.2 mg/kg subcutaneously), and 13 dogs received robenacoxib (2 mg/kg subcutaneously). Pain was scored with the Glasgow Composite Pain Scale (short form) before surgery and at 1, 6, 12, 18, and 24 hours after extubation. Rescue analgesia (tramadol, 3 mg/kg) was provided to dogs with a Glasgow pain score (GPS) ≥5. Glasgow pain scores were analyzed by ANOVA with treatment, age, and surgical time as fixed factors. RESULTS: Glasgow pain scores were higher at 24 hours postsurgery in dogs treated with robenacoxib (2.18 ± 0.29) compared with those treated with meloxicam (0.68 ± 0.41, P = .04). Two dogs treated with meloxicam and 7 dogs treated with robenacoxib required rescue analgesia. Regardless of the treatment, the overall GPS was lower at 18 and 24 hours postsurgery when the surgical time was >40 minutes compared with surgical times ≤40 minutes, but surgical site inflammation was likely a confounding factor in this finding. Glasgow pain score was not affected by patient age. CONCLUSION: Meloxicam was more effective than robenacoxib at controlling pain in the population of dogs reported here. CLINICAL SIGNIFICANCE: Preoperative administration of meloxicam effectively controls pain for 24 hours after combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy, but rescue analgesia may be required.

Simplified Minimally Invasive Surgical Approach for Prophylactic Laparoscopic Gastropexy in 21 Cases.

The objective of this study was to describe the operative technique and outcome of a simplified laparoscopic gastropexy approach in dogs. Twenty-one dogs undergoing prophylactic laparoscopic gastropexy with a simple continuous barbed suture without incising the seromuscular layer of the stomach and transversus abdominis muscle were reviewed. In 20 cases, additional procedures were performed (18 ovariectomies and 2 prescrotal castrations); 1 dog had two prior episodes of gastric dilation without volvulus and underwent gastropexy with a prophylactic intent. The gastropexy procedure had a median duration of 33 min (range 19-43 min). V-Loc 180 absorbable and the V-Loc PBT nonabsorbable suturing devices were used in 8 and 13 dogs, respectively. Minor intraoperative complications occurred in four cases: broken suture (1), needle dislodgement (2), and folded needle (1). Minor complications included self-limiting wound complications (3), abdominal discomfort (2), vomiting (1), and inappetence (2). Postoperative abdominal ultrasound performed after a median of 8 mo (6-36 mo) confirmed permanent adhesion at the gastropexy site in all dogs. One dog developed a fistula (1 yr postoperatively) and another a granuloma (3 mo postoperatively), both at the gastropexy site. Prophylactic laparoscopic gastropexy may be performed with knotless unidirectional barbed suture without creating an incision on the abdominal wall and stomach.

Gastric dilatation and volvulus in a 5-month-old Bernese mountain dog.

A 5-month-old Bernese mountain dog was presented for unproductive vomitus and abdominal distension. A gastric dilatation and volvulus was diagnosed. The dog underwent gastric derotation and incisional gastropexy. No intra- or post-operative complications occurred. Eight months following surgery, the dog was in excellent physical condition with no recurrence of clinical episodes of gastric dilatation. To the authors' knowledge, gastric dilatation and volvulus has not been previously reported in a puppy. This report underlines the importance of considering a prophylactic gastropexy in juvenile dogs with a known breed predisposition for gastric dilatation and volvulus.

Syndrome de dilatation torsion de l'estomac chez un Bouviers Bernois de 5 mois. Un Bouviers Bernois de 5 mois a été présenté pour des efforts de vomissements improductifs associés à une dilatation abdominale. Un syndrome de dilatation torsion de l'estomac a été diagnostiqué. Une dérotation gastrique et une gastropexie incisionnelle ont été réalisées. Aucune complication per- ou postopératoire n'est survenue. Huit mois après l'intervention chirurgicale, le chien présente un excellent état général sans récidive d'épisodes cliniques de dilatation gastrique. Il s'agit de la première description d'un syndrome de dilatation torsion de l'estomac chez un chiot. Ce cas souligne l'importance de considérer une gastropexie prophylactique précoce chez les chiens jeunes avec une prédisposition connue pour une dilatation torsion de l'estomac.(Traduit par les auteurs).

Total laparoscopic gastropexy using 1 simple continuous barbed suture line in 63 dogs.

OBJECTIVE: To describe the use and outcome of a single, simple continuous, barbed suture line for prophylactic, total laparoscopic gastropexy in dogs. STUDY DESIGN: Multi-center, retrospective case series. ANIMALS: Sixty-three client-owned dogs. METHODS: Medical records of dogs undergoing total laparoscopic gastropexy using a barbed suture at 4 academic veterinary hospitals from 2011-2015 were reviewed. Data collected included signalment, procedure time, procedure-associated complications, short-term complications, and long-term outcome. All procedures were performed under general anesthesia in dorsal to dorsal-left oblique recumbency. Laparoscopic ports were placed on ventral midline in 1 of 3 port configurations, and 5 mm laparoscopic needle drivers were used for intracorporeal sutured gastropexy with unidirectional barbed suture. The gastropexy was positioned just caudal to the 13th rib, 2-4 cm lateral to the rectus abdominis muscle. RESULTS: Sixty-three dogs underwent total laparoscopic gastropexy with a single, simple continuous, barbed suture line. Median gastropexy surgery time was 70 minutes (interquartile range [IQR] 60-90 minutes). One dog sustained splenic laceration from Veress needle penetration during initial abdominal insufflation. Short term (>24 hours to 6 months postoperative) complications included incisional seroma formation (n = 2) and suture reaction (n = 1). Long term (>6 months postoperative) complications included intermittent regurgitation and chronic diarrhea in 1 dog. Fifteen dogs had postoperative ultrasound and all had intact gastropexy sites. CONCLUSION: Total laparoscopic barbed gastropexy using a single, simple continuous, barbed suture line in dogs is safe and results in an intact gastropexy long term.

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.

OBJECTIVE: To compare two suturing techniques for prophylactic laparoscopic gastropexy in healthy dogs. STUDY DESIGN: Retrospective case series. ANIMALS: Thirty healthy client-owned dogs from breeds predisposed to gastric dilation volvulus. METHODS: Medical records of dogs presented for prophylactic laparoscopic gastropexy performed with knotless unidirectional barbed suture were reviewed. Dogs were grouped based on the device used for suturing, consisting of an endoscopic needle driver (END) vs an endoscopic suturing device (ESD). Signalment, weight, surgery time, number of suture bites per side of gastropexy, and intraoperative complications were compared between groups. RESULTS: The END group consisted of 10 dogs, with a median age of 1.09 years (range 0.5-2.67), weight of 41.5 kg (range 25-66), surgical time of 49.5 minutes (range 35-77), and a median of 5 suture bites per side (range 4-6). The ESD group included 20 dogs, with a median age of 1.75 years (range 0.6-8.75, P = .0944), weight was 37.5 kg (range 20-62, P = .5823), surgical time of 55 minutes (range 30-76, P = .808), and a median of 6 suture bites for the first side (range 4-7, P = .072) and 7 for the second side (range 4-8, P = .003). No major complications and no conversion to open celiotomy occured in either group. Minor complications occurred in 3 dogs in the ESD group, all related to device dysfunction and suture breakage. CONCLUSION: Laparoscopic gastropexy may be performed effectively with either of these suturing techniques.

Description and Biomechanical Comparison of a Percutaneous Radiologic Gastropexy Technique in a Canine Cadaver Model.

OBJECTIVE: To describe a novel percutaneous radiologic gastropexy (PRG) technique in a canine model and to biomechanically compare this technique to open incisional gastropexy (OIG) and laparoscopic-assisted incisional gastropexy (LAG). STUDY DESIGN: Randomized ex vivo biomechanical study. ANIMALS: Canine cadavers. METHODS: Fifteen cadavers were randomized to 1 of 3 surgical interventions: OIG, LAG, and PRG. For the PRG procedure, the stomach was distended with air, and a preloaded T-fastener device was utilized to attach the stomach to the body wall with fluoroscopic-guidance. The procedural times of the 3 techniques were recorded. After completion of the procedure, the stomach and body wall overlying the stomach wall were harvested and the maximum tensile strength of the gastropexies was determined. RESULTS: The maximal tensile strength was not significantly different between groups. The total procedural time for the PRG procedure (5 minutes) was significantly shorter than both OIG (28 minutes) and LAG (20 minutes) procedures. CONCLUSION: The PRG technique described in this study demonstrated a similar maximal tensile strength to commonly employed gastropexy techniques (OIG and LAG) in an acute canine model. Additionally, the PRG procedure was significantly faster to perform. The clinical relevance of this technique will be determined by further study to assess the applicability and efficacy of this procedure in clinical patients by determining the likelihood of adhesion development and the ability of the adhesion to prevent gastric volvulus.

Efficacy of Two Radiologic-Assisted Prophylactic Gastropexy Techniques.

OBJECTIVE: To describe the technique and clinical outcome of prophylactic percutaneous radiologic-assisted gastropexy (PRG) and radiologic-assisted incisional gastropexy (RIG) in client-owned dogs. STUDY DESIGN: Prospective, nonrandomized clinical trial. ANIMALS: Fourteen client-owned, large, and giant breed dogs. METHODS: Four dogs underwent PRG with fluoroscopic guidance to place 2 T-fasteners into the pyloric antrum and secure it to the right body wall. Ten dogs underwent RIG, which was a modification of PRG. For RIG, the T-fasteners were first used to approximate the pyloric antrum and body wall, then a full thickness incision through the body wall was made and the pyloric antrum was sutured to the internal abdominal wall. The duration and complications of each procedure were recorded. The gastropexy was assessed by abdominal ultrasound at day 1, week 2, and week 8 postoperative and by barium gastrogram at week 8 postoperative. RESULTS: No dogs undergoing PRG had a gastropexy present at week 2. All dogs undergoing RIG had ultrasonographic evidence of gastropexy at day 1, week 2, and week 8 postoperative. Gastrograms in 9/9 dogs were consistent with an intact gastropexy, appropriate gastric positioning and appropriate gastric emptying began. No major complications were noted. CONCLUSION: The PRG was unsatisfactory and did not result in a permanent gastropexy. The RIG was safe and created a gastropexy that remained intact at 8 weeks postoperative. The RIG should be considered as a minimally invasive option for prophylactic gastropexy in dogs of at-risk breeds.

Laparoscopic Gastropexy Using Knotless Unidirectional Suture and an Articulated Endoscopic Suturing Device: Seven Cases.

OBJECTIVE: To describe a technique for laparoscopic incisional gastropexy using an articulated endoscopic suturing device with knotless unidirectional barbed suture in healthy large breed dogs. STUDY DESIGN: Prospective case series. ANIMALS: Healthy client-owned dogs presented for prophylactic gastropexy and weighing >20 kg (n=7). METHODS: Incisional gastropexy was performed using a single port access system with an articulated endoscopic suturing device. An additional 5 mm cannula was placed in the right caudal abdomen. A 2-0 knotless unidirectional barbed suture was used to complete the gastropexy with 2 separate simple continuous suture lines. All dogs underwent a focal abdominal ultrasound to evaluate the gastropexy site 3-12 months postoperatively. RESULTS: Median weight of the dogs was 33.5 kg (range, 20-51 kg) and the median age was 2 years (range, 0.6-8.5 years). Median surgical time was 60 minutes (range, 39-88). The articulated suturing device malfunctioned twice. On abdominal ultrasound between 3 and 12 months, all gastropexy sites were intact. No motion was detected between the stomach and body wall during distal antral contractions or respiratory motion and a focal thickening of the gastric wall was present in dog. No complications were reported in the postoperative periods as of the 2 week suture removal visit or as of the time of their ultrasound appointment. CONCLUSION: This technique using an endoscopic articulated suturing device with a knotless unidirectional barbed suture provides a feasible technique to perform laparoscopic gastropexy.

Long-Term Outcome and Complications Following Prophylactic Laparoscopic-Assisted Gastropexy in Dogs.

OBJECTIVE: To characterize the short- and long-term outcome (>12 months), complications, and owner satisfaction following prophylactic laparoscopic-assisted gastropexy (LAG) in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs (n = 49). METHODS: Dogs that underwent prophylactic LAG at 2 veterinary academic hospitals were studied. Surgical time, anesthesia time, concurrent intra- and extra-abdominal procedures, and intraoperative and postoperative complications were recorded following review of medical records. Veterinarian and/or owner follow-up was obtained to determine outcome and satisfaction with LAG. RESULTS: Five of 49 dogs (10%) experienced complications related to abdominal access during LAG. Four percent (2/49) of dogs experienced an intraoperative complication. Follow-up information was available for 89% of dogs (44/49). Four dogs died of causes unrelated to LAG or gastric dilatation volvulus (GDV) in the follow-up period. Two dogs experienced major postoperative complications requiring additional veterinary intervention. Thirty percent (13 dogs) experienced a minor postoperative self-limiting wound-related complication. Median follow-up time was 698 days (range, 411-1825). No dogs experienced GDV. One hundred percent of dog owners were satisfied with LAG, would repeat the procedure in a future pet, and would recommend the procedure to a friend or family member. CONCLUSION: LAG was an effective procedure for prevention of GDV and was associated with high client satisfaction in this cohort of dogs. A moderate rate of postoperative wound complications occurred that were minor and self-limiting in nature.