RESUMO
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.
Assuntos
Dilatação Gástrica , Gastropexia , Terapia com Luz de Baixa Intensidade , Volvo Gástrico , Terapia com Luz de Baixa Intensidade/veterinária , Gastropexia/veterinária , Animais , Cães , Dilatação Gástrica/cirurgia , Volvo Gástrico/cirurgia , Medetomidina/administração & dosagem , Meloxicam/administração & dosagem , Butorfanol/administração & dosagem , Propofol/administração & dosagem , Sevoflurano/administração & dosagem , Resultado do Tratamento , Anestesia , Analgesia , Medição da Dor/veterinária , Analgésicos/administração & dosagemRESUMO
OBJECTIVE: To describe near-infrared fluorescence (NIRF) for assessment of gastric viability and describe NIRF's influence on the surgeon's operative strategy in dogs with gastric dilatation and volvulus (GDV). STUDY DESIGN: Prospective clinical trial. ANIMALS: Twenty dogs with GDV and 20 systemically healthy dogs. METHODS: Following gastric derotation, the surgeon's subjective assessment of gastric viability was recorded prior to near-infrared imaging. Changes in the surgeon's initial assessment of viability based on the visual pattern of gastric fluorescence was recorded. If nonviable (lack of defined vessels), a partial gastrectomy was performed and submitted for histopathology. The stapled gastrectomy line was imaged. Viable (defined vessels) and nonviable fluorescence intensities were compared with healthy dogs undergoing surgery for nongastrointestinal disease. RESULTS: Subjective assessment diagnosed 17 viable and three nonviable GDVs (2 fundi; 1 cardia). Near-infrared imaging demonstrated nonviable gastric fluorescence in 4 dogs (3 fundi/cardia; 1 fundus). The surgeon's margins for resection were altered in 3/20 dogs. Fluorescence intensity (cardia, fundus, body, pylorus) was lower in GDV viable (30.59%, p = .04; 38.17%, p < .01; 51.18%, p < .01; 44.12%, p= .01) and nonviable (11.00%, p < .01; 4.33%, p < .01; 57.67%, p = .22; 54.33%, p = .72) dogs compared to healthy controls (44.7%, 70.05%, 84.00%, 63.95%). Fundic fluorescence was less in nonviable gastric tissue in comparison with viable gastric tissue (p = .03). Fluorescence of the gastrectomy staple line approximated that of viable tissue. CONCLUSION: Near-infrared fluorescence can identify histologically confirmed nonviable gastric tissue. CLINICAL SIGNIFICANCE: These results provide enough evidence to support the implementation of NIRF as an adjunct to gross examination of the gastric wall in dogs with GDV.
Assuntos
Doenças do Cão , Volvo Gástrico , Animais , Cães , Doenças do Cão/cirurgia , Doenças do Cão/diagnóstico por imagem , Volvo Gástrico/veterinária , Volvo Gástrico/cirurgia , Volvo Gástrico/diagnóstico por imagem , Feminino , Estudos de Casos e Controles , Masculino , Gastrectomia/veterinária , Gastrectomia/métodos , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho/veterinária , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Dilatação Gástrica/veterinária , Dilatação Gástrica/cirurgia , Dilatação Gástrica/diagnóstico por imagem , Imagem Óptica/veterinária , Imagem Óptica/métodos , Estômago/diagnóstico por imagem , Estômago/cirurgia , FluorescênciaRESUMO
OBJECTIVE: To report the outcomes and complications associated with prophylactic incisional gastropexy performed in dog breeds at risk for GDV. RESULTS: Seven hundred and sixty-six dogs underwent prophylactic incisional gastropexy of which 61 were electively performed at the time of castration or spay and 705 were adjunctively performed at the time of emergency abdominal surgery. All dogs had short-term follow-up, and 446 dogs (58.2%) had additional follow-up with a median long-term follow-up time of 876 days (range 58-4450). Only 3 dogs (0.4%) had a direct complication associated with the gastropexy site including hemorrhage causing hemoabdomen (2) and infection with partial dehiscence (1). No dogs with long-term follow-up experienced gastric dilatation (GD), gastric dilatation volvulus (GDV), or persistent GI signs following gastropexy. Results of this study found that complications directly associated with prophylactic gastropexy were rare and limited to hemorrhage causing hemoabdomen and infection with partial dehiscence. Transient postoperative GI signs may occur. Gastropexy malpositioning and bowel entrapment were not encountered. There was no occurrence of GD or GDV.
Assuntos
Doenças do Cão , Dilatação Gástrica , Gastropexia , Volvo Gástrico , Cães , Animais , Dilatação Gástrica/etiologia , Dilatação Gástrica/prevenção & controle , Dilatação Gástrica/cirurgia , Gastropexia/efeitos adversos , Gastropexia/métodos , Gastropexia/veterinária , Doenças do Cão/cirurgia , Volvo Gástrico/etiologia , Volvo Gástrico/cirurgia , Volvo Gástrico/veterinária , HemoperitônioRESUMO
We have written a "letter to Editor" about a case of gastric dilatation caused by a symptomatic gastric duplication cyst with ectopic pancreas ingrowth, in a 13 years old boy. The Endoscopy Ultra Sound characterized the lesion and permitted the aspiration of the internal liquid. The patient underwent to laparoscopic excision of the mass and the histology revealed a gastric duplication cyst with ectopic pancreas ingrowth.
Assuntos
Cistos , Dilatação Gástrica , Laparoscopia , Masculino , Humanos , Adolescente , Cistos/complicações , Cistos/diagnóstico por imagem , Cistos/cirurgia , Dilatação Gástrica/diagnóstico por imagem , Dilatação Gástrica/etiologia , Dilatação Gástrica/cirurgia , Endossonografia , PâncreasRESUMO
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).
Assuntos
Doenças do Cão , Dilatação Gástrica , Gastropexia , Volvo Intestinal , Volvo Gástrico , Animais , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/cirurgia , Cães , Dilatação Gástrica/complicações , Dilatação Gástrica/cirurgia , Dilatação Gástrica/veterinária , Gastropexia/veterinária , Volvo Intestinal/complicações , Volvo Intestinal/veterinária , Masculino , Volvo Gástrico/complicações , Volvo Gástrico/cirurgia , Volvo Gástrico/veterináriaRESUMO
OBJECTIVE: To compare the outcomes of dogs surgically treated for gastric dilatation volvulus (GDV) after rapid versus prolonged medical stabilization. STUDY DESIGN: Prospective cohort study, monoinstitutional. SAMPLE POPULATION: One hundred and sixty-two dogs with GDV. METHODS: Dogs presenting with a GDV were allocated to 1 of 2 groups, immediate or delayed. In the immediate group, dogs were stabilized for 90 min prior to undergoing surgery. In the delayed group, dogs underwent surgery after at least 5 h of stabilization. Medical stabilization included gastric decompression and placement of an indwelling nasogastric tube to prevent further gastric dilatation in all dogs. Short-term outcomes were compared between surgical timings by univariate and multivariate analyses. RESULTS: Dogs (n = 89) in the immediate group underwent surgery a median time of 2.1 h after presentation (range 1.9-2.5 h), whereas those in the delayed surgery group (n = 73) were operated a median time of 9.8 h (range 5.4-13.7 h) after presentation. Survival rates did not differ between dogs undergoing immediate or delayed surgery at discharge (70/89 and 60/73, respectively) or at 1 month postoperatively (68/89 and 55/73, respectively). The degree of gastric torsion was differently distributed between the 2 groups (P = .05). In the immediate group, 19, 52, and 9 dogs had a 0°, 180° and 270° gastric torsion respectively, whereas in the delayed group, 27, 32, and 5 dogs had a 0°, 180° and 270° gastric torsion respectively. Hyperlactatemia 24 h after initiation of fluid therapy was associated with an increased in-hospital mortality risk and at 1 month postoperatively. CONCLUSION: No survival benefit was detected as a result of proceeding to surgery after either a rapid or a prolonged medical stabilization. CLINICAL SIGNIFICANCE: The aggressive stabilization and monitoring protocol described here can be considered as an alternative to stabilize dogs with GDV prior to surgery within 13.7 h of presentation. Further research is required to investigate the potential risks and benefits of prolonged over rapid stabilization and to identify candidates for each approach.
Assuntos
Doenças do Cão , Dilatação Gástrica , Volvo Intestinal , Volvo Gástrico , Animais , Doenças do Cão/cirurgia , Cães , Dilatação Gástrica/cirurgia , Dilatação Gástrica/veterinária , Volvo Intestinal/veterinária , Estudos Prospectivos , Volvo Gástrico/cirurgia , Volvo Gástrico/veterináriaRESUMO
Gastric dilatation and volvulus (GDV) is an acute, life-threatening syndrome of dogs, particularly large and giant breeds with a deep chest conformation. Rapid diagnosis is important for prompt initiation of stabilization therapy and surgical correction. Negative prognostic factors include hyperlactatemia not responding to fluid therapy, gastric perforation, or need for splenectomy or gastric resection. Gastropexy is essential for all dogs affected by GDV, following correct gastric repositioning. Prophylactic gastropexy for at-risk breeds can be performed via minimally invasive laparoscopic surgery.
Assuntos
Doenças do Cão , Dilatação Gástrica , Gastropexia , Volvo Intestinal , Volvo Gástrico , Animais , Doenças do Cão/prevenção & controle , Doenças do Cão/cirurgia , Cães , Dilatação Gástrica/prevenção & controle , Dilatação Gástrica/cirurgia , Dilatação Gástrica/veterinária , Gastropexia/veterinária , Volvo Intestinal/cirurgia , Volvo Intestinal/veterinária , Volvo Gástrico/prevenção & controle , Volvo Gástrico/cirurgia , Volvo Gástrico/veterináriaRESUMO
Acute gastric dilatation (AGD) is usually related to eating disorders, postoperative status and mechanical obstruction of the duodenum. When intragastric pressure is augmented, it can lead to alteration of blood flow and result in transmural necrosis. However, there are very few reports on idiopathic AGD and so here we describe the case of a 26-year-old woman diagnosed with AGD without any apparent cause. Conservative treatment was initially conducted, but because of the persistence of dilatation, presence of gastric ulcer and gastric pneumatosis, a surgical approach was necessary. During surgery, gastric necrosis was observed in the greater curvature. A sleeve gastrectomy was conducted from the angle of His to the antrum. No complications were present during the postoperative course. Oeso-gastro-duodenal barium study showed no signs of gastric emptying and psychiatric evaluation ruled out any eating disorder.
Assuntos
Gastrectomia/métodos , Dilatação Gástrica/cirurgia , Estômago/patologia , Doença Aguda , Adulto , Feminino , Dilatação Gástrica/complicações , Dilatação Gástrica/patologia , Humanos , Necrose/complicaçõesRESUMO
Background: Bariatric surgery is an effective treatment for obesity and its associated morbidities. They are safe surgeries, their general complication rate is 0%-10%. However, acute gastric dilation is an unusual complication. It requires rapid diagnosis and treatment to avoid major complications. Image-guided surgery represents a group of minimally invasive procedures. Acute gastric dilation is a complication that can benefit from the application of this type of procedure. We present a report of patients with acute gastric dilation of the remnant as a complication after bariatric surgery, its resolution through image-guided surgery, and updating. Materials and Methods: A retrospective review of patients who presented postoperative complications after bariatric surgery was carried out. The time period was 10 years. All patients were operated on in a single center by the same surgical team. Results: A total of 3507 bariatric procedures were analyzed (sleeve gastrectomy, 1929-55.1% ± 0.49%; Roux-en-Y gastric bypass [RYGB], 1403-40% ± 0.48%; other techniques, 175-4.9% ± 0.21%). The RYGB branch reported a total of 11 (0.78% ± 0.08%) complications, of which 2 (0.14% ± 0.03%) were reported as acute gastric dilation of the remnant. Conclusions: Acute gastric dilation of the post-RYGB remnant is a rare complication, but it can be serious. It is necessary to have a high suspicion to obtain an early diagnosis and treatment. Percutaneous gastrostomy is an image-guided procedure that can solve the problem temporarily or permanently.
Assuntos
Derivação Gástrica/efeitos adversos , Dilatação Gástrica/cirurgia , Obesidade Mórbida/cirurgia , Adulto , Feminino , Coto Gástrico/cirurgia , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Cirurgia Assistida por ComputadorRESUMO
OBJECTIVE: To evaluate a staged technique of immediate decompressive and delayed surgical treatment for gastric dilatation-volvulus (GDV) in dogs. ANIMALS: 41 client-owned dogs with confirmed GDV from 2012 through 2016. PROCEDURES: Medical record data were collected regarding patient signalment, diagnostic test results, gastric lavage findings, surgical findings, and short-term survival status. For all dogs, gastric decompression was performed by orogastric intubation and gastric lavage in the same anesthetic episode. If this stage was successful, subsequent corrective surgery (laparotomy and gastropexy) was delayed and performed in a second anesthetic episode. RESULTS: 6 dogs underwent corrective surgery in the same anesthetic session as for decompression and stabilization, 2 of which had gastric necrosis. Thirty-five dogs underwent corrective surgery in a second anesthetic episode a mean of 22.3 hours (range, 5.25 to 69.75 hours) after presentation, during which gastric necrosis was identified in 2 dogs. The mortality rate for delayed-surgery patients was 9% (3/35). Time from presentation to surgery was not associated with surgeon subjective assessment of gastric health status or mortality rate. Intraoperative identification of gastric necrosis was associated with nonsurvival. Single plasma lactate concentrations and percentage change in serial lactate concentrations were associated with intraoperative gastric health status and mortality rate. CONCLUSIONS AND CLINICAL RELEVANCE: The observed mortality rate for delayed-surgery patients was comparable to rates reported for other GDV treatment techniques. Results suggested that delaying corrective surgery is possible for certain dogs, but careful case selection would be important and no reliable preoperative case selection criteria were identified. Additional research is needed to further investigate the potential risks and benefits of staged versus immediate surgical treatment of GDV in dogs.
Assuntos
Doenças do Cão , Dilatação Gástrica , Gastropexia , Volvo Intestinal , Volvo Gástrico , Animais , Doenças do Cão/cirurgia , Cães , Dilatação Gástrica/cirurgia , Dilatação Gástrica/veterinária , Gastropexia/veterinária , Volvo Intestinal/veterinária , Volvo Gástrico/cirurgia , Volvo Gástrico/veterináriaRESUMO
Acute massive gastric dilatation (AMGD) is a rare event which is usually underdiagnosed. It can occur due to multiple etiologies, including medical and surgical, or as a postoperative complication. We report a rare case of AMGD as a result of closed-loop obstruction of the stomach following feeding jejunostomy in a patient with carcinoma oesophagus. A high index of suspicion, early diagnosis and prompt management is the key to the successful treatment. To the best of our knowledge, this is the second case report of a closed-loop obstruction of the stomach leading to AMGD in published literature.
Assuntos
Transtornos de Deglutição/cirurgia , Nutrição Enteral/métodos , Dilatação Gástrica/diagnóstico , Obstrução da Saída Gástrica/diagnóstico , Jejunostomia/efeitos adversos , Carcinoma/complicações , Carcinoma/radioterapia , Descompressão , Transtornos de Deglutição/etiologia , Drenagem , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/radioterapia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Dilatação Gástrica/etiologia , Dilatação Gástrica/cirurgia , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Gastrostomia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estômago/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
An 8-year-old boy with a history of multiple neonatal laparotomies, including congenital diaphragmatic hernia repair and an open fundoplication, presented acutely with severe abdominal pain, distension, vomiting and shock. A large abnormal opacity in the left upper quadrant was visible on a plain abdominal radiograph. The patient was taken to the theatre for emergency laparotomy and was found to have a massively distended stomach, the fundus and body of which were necrotic. A subtotal gastrectomy was performed, sparing the viable tissue. The patient went on to make a full recovery. Acute massive gastric dilatation (AMGD) is a rare condition characterised by severe gastric distension. Gastric ischaemia results when intragastric pressure exceeds venous pressure, obstructing venous outflow. It is important to recognise AMGD as a severe complication of fundoplication due to closed-loop gastric obstruction. It should prompt consideration of an early laparotomy in cases where the diagnosis is suspected.
Assuntos
Fundoplicatura/efeitos adversos , Dilatação Gástrica/etiologia , Dor Abdominal/etiologia , Doença Aguda , Criança , Dilatação Gástrica/diagnóstico por imagem , Dilatação Gástrica/cirurgia , Humanos , MasculinoRESUMO
A 9 yr old castrated male mixed-breed dog was presented for acute vomiting. Abdominal radiographs appeared to show a normal positioned stomach with marked gas dilation, which persisted despite frequent suctioning with a nasogastric tube. An abdominal ultrasound showed splenomegaly, malpositioning of the spleen, and the pyloroduodenal junction. A ventral midline celiotomy revealed an organoaxial gastric volvulus, rotating on the gastroesophageal, and pyloroduodenal junctions. The omentum was not overlying the stomach, typically seen in mesenteroaxial gastric volvulus. The body of the stomach was derotated with no evidence of gastric necrosis noted. The spleen was in the right cranial abdomen and returned to its normal anatomic position after derotation of the stomach. The patient recovered uneventfully and was discharged the next day. To the authors' knowledge, organoaxial gastric volvulus has not been reported in dogs. This is rare in humans but occurs most commonly in children <5 yr of age associated with hernias. The recommended treatment is surgical in majority of cases. As a result of the unusual orientation of the stomach, the diagnosis of gastric dilatation-volvulus was challenging. Organoaxial gastric volvulus demonstrates the need for further imaging and evaluation in cases of persistent gas dilation.
Assuntos
Doenças do Cão/patologia , Dilatação Gástrica/veterinária , Volvo Gástrico/veterinária , Animais , Doenças do Cão/cirurgia , Cães , Dilatação Gástrica/patologia , Dilatação Gástrica/cirurgia , Masculino , Volvo Gástrico/patologia , Volvo Gástrico/cirurgiaRESUMO
OBJECTIVE: To evaluate the feasibility of ultrasound-guided, temporary, percutaneous T-fastener gastropexy (TG) and gastrostomy catheter (GC) placement for providing sustained gastric decompression in dogs with acute gastric dilatation-volvulus (GDV) and to compare findings with those of trocarization. ANIMALS: 16 dogs with GDV. PROCEDURES: Dogs were randomly assigned to undergo gastric decompression by means of percutaneous trocarization (trocar group; n = 8) or temporary TG and GC placement (TTG+GC group; 8) with ultrasound guidance. The gastric volvulus was then surgically corrected, and the decompression sites were examined. Outcomes were compared between groups. RESULTS: The proportion of dogs with successful decompression did not differ significantly between the TTG+GC (6/8) and trocar (7/8) groups; median procedure duration was 3.3 and 3.7 minutes, respectively. After the failed attempts in the TTG+GC group, the procedure was modified to include ultrasound guidance during T-fastener placement. The decrease in intragastric pressure by 5 minutes after trocar or GC insertion was similar between groups. For dogs in the TTG+GC group, no significant difference in intragastric pressure was identified between 5 and 60 minutes after GC insertion. Complications included inadvertent splenic or jejunal placement in 2 dogs (TTG+GC group) and malpositioned and ineffective trocar placement in 1 dog (trocar group). All dogs survived for at least 2 weeks. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasound-guided, temporary, percutaneous TG and GC placement was safe and effective at providing sustained gastric decompression in dogs with GDV, suggesting that this technique would be ideal for dogs in which surgical delays are anticipated or unavoidable.
Assuntos
Doenças do Cão/cirurgia , Dilatação Gástrica/veterinária , Gastropexia/veterinária , Gastrostomia/veterinária , Volvo Intestinal/veterinária , Volvo Gástrico/veterinária , Animais , Cães , Dilatação Gástrica/cirurgia , Gastropexia/métodos , Gastrostomia/métodos , Volvo Intestinal/cirurgia , Volvo Gástrico/cirurgia , Ultrassonografia de Intervenção/veterináriaRESUMO
Some patients may experience inadequate weight loss or weight regain due to gastric pouch dilation after one anastomosis gastric bypass (OAGB). Dilated gastric pouch resizing (GPR) associated with correction of eating behavior was suggested as an option in the management of these patients. Retrospective analysis of 17 consecutives patients who underwent a GPR between 2007 and 2017 was undertaken. At revision, the mean body mass index (BMI) and percentage of total weight loss (%TWL) were 41.5 ± 11 kg/m2 and 15 ± 10, respectively. Overall morbidity rate was 6.7% (n = 1). Two years after revision, the mean BMI and %TWL were 34.1 ± 5 kg/m2 and 31 ± 13, respectively. GPR appeared to be a satisfactory option resulting in mid-term secondary weight loss in well selected patients at the expense of non-negligible morbidity rate.
Assuntos
Derivação Gástrica/efeitos adversos , Dilatação Gástrica/etiologia , Dilatação Gástrica/cirurgia , Obesidade Mórbida/cirurgia , Parede Abdominal/cirurgia , Adulto , Índice de Massa Corporal , Feminino , Derivação Gástrica/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Reoperação/métodos , Estudos Retrospectivos , Pele , Redução de PesoRESUMO
AIM: The aim of this study was to present an overview of the gastric dilatation-volvulus syndrome in guinea pigs. MATERIAL AND METHODS: Four cases of gastric dilatation-volvulus syndrome in guinea pigs were evaluated. Its clinical presentation, diagnostic options, therapeutical approach and possible alternatives thereof were discussed. Furthermore, risk factors for the disease as well as pathophysiology and etiology were discussed and compared to the situation in other species. RESULTS: The presented cases indicate that in addition to anamnesis and clinical examination, radiography is the means of choice to diagnose a gastric dilatation-volvulus syndrome in guinea pigs. All four patients underwent surgery. One animal was euthanized during surgery, the other three guinea pigs died postoperatively. CONCLUSION AND CLINICAL RELEVANCE: Gastric dilatation-volvulus syndrome in guinea pigs is considered to be an emergency and, therefore, immediate stabilization is necessary, as well as surgery in almost all cases. The prognosis of this disease is guarded to poor.
Assuntos
Dilatação Gástrica/veterinária , Doenças dos Roedores/diagnóstico , Doenças dos Roedores/cirurgia , Volvo Gástrico/veterinária , Animais , Feminino , Dilatação Gástrica/diagnóstico , Dilatação Gástrica/cirurgia , Cobaias , Masculino , Volvo Gástrico/diagnóstico , Volvo Gástrico/cirurgia , SíndromeRESUMO
BACKGROUND: The management of gastric cancer causing gastric outlet obstruction and dilatation must include decompression of the stomach and intravenous nutrition. Percutaneous transesophageal gastrotubing (PTEG) is an effective technique for either gastric decompression or enteral nutrition. Here, we investigated the efficacy and safety of double PTEG (dPTEG), that is, using PTEG for both purposes simultaneously, in patients with gastric cancer. MATERIALS AND METHODS: Eleven patients with gastric outlet obstruction due to gastric cancer were admitted to our hospital between January 2015 and March 2017 and enrolled in this study. Each patient underwent dPTEG as soon as possible. After dPTEG tubes were placed, gastric decompression was started immediately and enteral nutrition was started within 1 d. Feeding and decompression through the double tubes were continued until the day before operation. Using data from these patients, we investigated the efficacy and safety of dPTEG. RESULTS: dPTEG was performed successfully in all patients and no critical adverse effects were observed. Eight of the 11 patients underwent radical or palliative resection. Decompression of the stomach was achieved and nutritional status was significantly improved after dPTEG in all patients. CONCLUSIONS: We conclude that dPTEG is a safe and effective management technique for patients with gastric outlet obstruction and gastric dilatation due to gastric cancer.
Assuntos
Descompressão Cirúrgica/métodos , Nutrição Enteral , Dilatação Gástrica/cirurgia , Obstrução da Saída Gástrica/cirurgia , Neoplasias Gástricas/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Intubação Gastrointestinal , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pré-Albumina/análiseRESUMO
This study evaluated the association between a selection of candidate predictor variables, including the elevation of specific pancreatic enzymes, and outcome in dogs with gastric dilatation-volvulus (GDV). Twenty-two dogs with gastric dilatation-volvulus were included, being classified as survivors or non-survivors based on the final outcome. Dogs with intestinal obstruction (n = 16) were selected for comparison. Blood samples were collected upon admission (T0) and after 24 hours (T1). Serum lipase activity, canine pancreatic lipase immunoreactivity (cPLI) and other variables (plasma lactate concentration and C- reactive protein -CRP- in particular) were evaluated as predictive variables. T0 cPLI and serum lipase activity were not found to differ significantly between dogs with gastric dilatation-volvulus or intestinal obstruction. Canine pancreatic lipase immunoreactivity values above 400 µg/L were detected in 6/22 dogs with gastric dilatation-volvulus and 4/16 with intestinal obstruction. However, lactate concentration was significantly higher and CRP significantly lower in GDV as compared to IO dogs, and in the GDV group, lipase, cPLI and CRP measured upon admission were significantly associated with a negative outcome. No differences in lipase activity and canine pancreatic lipase immunoreactivity values were detected between T0 and T1. Presurgical cPLI and lipase activity were frequently increased during gastric dilatation-volvulus and were suggestive of the presence of pancreatic damage; while more extensive studies are required, based on this pilot analysis, cPLI has the potential to be a useful predictive variable for outcome in GDV. Further to this, serum CRP was able to predict outcome in this population of dogs with GDV, while blood lactate was not.
Assuntos
Doenças do Cão/cirurgia , Dilatação Gástrica/veterinária , Volvo Intestinal/veterinária , Lipase/metabolismo , Animais , Proteína C-Reativa/metabolismo , Doenças do Cão/metabolismo , Cães , Feminino , Dilatação Gástrica/metabolismo , Dilatação Gástrica/cirurgia , Hospitalização , Obstrução Intestinal , Volvo Intestinal/metabolismo , Volvo Intestinal/cirurgia , Ácido Láctico/metabolismo , Masculino , Pâncreas/enzimologia , Prognóstico , Estudos Prospectivos , Curva ROCRESUMO
Gastropexy is a surgical technique performed to prevent and decrease the recurrence rate of gastric dilatation and volvulus (GDV). The objective of this prospective, a descriptive cohort study on 100 client-owned dogs who were presented with GDV, is to describe a modified belt-loop gastropexy and determine its intraoperative complications and long-term efficacy. The transversus abdominis muscle was used to make an oblique belt-loop. A seromuscular antral fold, instead of a seromuscular antral flap, was passed through the belt-loop, and then, the passed portion of the antral fold was sutured to the dissected edge of the abdominal wall. Intraoperative complications related to gastropexy were recorded, and the incidence of GDV recurrence was determined a minimum of 1 yr postoperatively via telephone with the referring veterinarians and the owners. There were no intraoperative complications related to the modified belt-loop gastropexy technique. Based on follow-up conversations, none of the dogs presented signs of GDV recurrence during the follow-up period. Based on the results, there is strong clinical evidence that a modified belt-loop gastropexy prevents recurrence of GDV in dogs surviving an acute episode.