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).

Outcomes and complications of prophylactic incisional gastropexy in 766 dogs (2009-2019).

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.

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).

Comparison of incisional gastropexy with and without addition of two full-thickness stomach to body wall sutures.

OBJECTIVE: To compare complications between a modified incisional gastropexy (MIG) technique and standard incisional gastropexy (SIG). ANIMALS: 347 client-owned dogs. PROCEDURES: Dogs that had undergone SIG or MIG from March 2005 through April 2019 were identified through a medical record search of the University of Missouri Veterinary Health Center. The MIG technique is identical to SIG except 2 additional simple interrupted sutures are added, 1 cranial and 1 caudal to the continuous suture line, going full thickness into the stomach to ensure engagement of submucosa. Medical record information was used to identify intraoperative, postoperative, and short-term complications, and telephone or email communication to pet owners and/or referring veterinarians was used to identify complications (short-term and long-term) after discontinuance of care at the University of Missouri Veterinary Health Center. Intraoperative, postoperative, short-term, and long-term complications were analyzed in aggregate within 6 matched groupings: (1) gastropexy for gastric dilatation-volvulus, (2) prophylactic gastropexy without other procedures, (3) gastropexy with ovariohysterectomy, (4) gastropexy with castration, (5) gastropexy with splenectomy, and (6) gastropexy with celiotomy other than splenectomy. Overall rates of complications potentially attributed to gastropexy were compared between SIG and MIG using the Fisher exact test. Overall rates of complications not attributed to gastropexy were compared between SIG and MIG using the χ2 test. RESULTS: There were no significant differences in overall complication rates between SIG and MIG. CLINICAL RELEVANCE: Surgeons who feel that engagement of gastric submucosa is important for gastropexy success may use the MIG technique with minimal fear of complications. However, superiority of one technique over the other cannot be determined on the basis of this study.

Addition of two full-thickness simple interrupted sutures to standard incisional gastropexy increases gastropexy biomechanical strength.

OBJECTIVE: To compare the acute strength (failure load and work to failure) of standard incisional gastropexy (SIG) and modified incisional gastropexy (MIG). ANIMALS: 37 pig cadavers. PROCEDURES: Stomachs and right abdominal walls were harvested from pigs euthanized for reasons unrelated to this study. The tissues were stored in lactated Ringer's solution overnight in a 5 °C cooler. Matching body wall and stomach tissue pairs were randomized and divided into 2 groups, on which either SIG or MIG was performed the following day. The MIG technique was identical to SIG except 2 additional simple interrupted sutures, 1 cranial and 1 caudal to the continuous suture line, were placed full thickness into the stomach to ensure engagement of the submucosa. After gastropexy, the samples underwent biomechanical testing. Information regarding change in position and load was generated by the MTESTQuattro software. Mode of failure was examined after the procedure was complete. RESULTS: The MIG had higher failure load and work to failure compared to SIG. All failures were caused by gastric tissue tearing. CLINICAL RELEVANCE: The MIG is biomechanically superior to SIG and may provide more security than SIG during healing. However, clinical study is needed to ascertain if there is a difference in gastropexy failure and complications between these 2 techniques.

Is pneumothorax secondary to pneumoperitoneum a real risk in dogs undergoing total laparoscopic gastropexy?

Background: There were described in veterinary literature, the possibility of pneumothorax as a complication of laparoscopic surgery in dogs undergoing laparoscopic ovariectomy associated with total laparoscopic gastropexy. Aim: To assess if spontaneous pneumothorax secondary to pneumoperitoneum is a real risk in dogs undergoing total laparoscopic gastropexy. Methods: Dogs undergoing totally laparoscopic gastropexy received chest X-rays (CXR) in lateral (left and right) and ventro-dorsal projection before and after the surgery. Two veterinary radiologists reported the x-rays and indicated the presence or not of pneumothorax. Results: Postoperative pneumothorax was not detected on postoperative CXR in the total of 76 dogs of the study. Conclusion: The odds risk of pneumothorax after total laparoscopic gastropexy surgical procedure is low.

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).

Updated Information on Gastric Dilatation and Volvulus and Gastropexy in Dogs.

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.

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).

Comparison of total laparoscopic gastropexy with the Ethicon Securestrap fixation device versus knotless barbed suture in dogs.

BACKGROUND: This study evaluated the feasibility and efficacy of a laparoscopic absorbable fixation device (Securestrap) in total laparoscopic gastropexy in dogs susceptible to gastric dilatation-volvulus (GDV) compared to laparoscopic gastropexy performed with a barbed suture. We hypothesised that both techniques provide suitable gastropexy. METHODS: The gastropexy was performed by straps (TLG-SS group, n = 6) or with a barbed suture (TLG-Vloc group, n = 6). The total surgery time, gastropexy time, the number of straps used and suture bites were recorded. Clinical and ultrasound investigations were performed during follow-up. RESULTS: The total surgery time was 30 minutes in the TLG-SS, while it was 46.66 minutes in the TLG-Vloc. In the TLG-SS group, gastropexy time was 13 minutes, while 36.3 minutes in the TLG-Vloc. The number of straps employed in TLG-SS was 9, while seven bites were employed in TLG-Vloc. Linear regression analysis of gastropexy time versus the number of procedures was highly correlated (r2 = 0.84) in the TLG-SS. Complications, clinical and ultrasound findings did not differ between the two techniques at 90 days post-surgery. CONCLUSION: TLG-SS laparoscopic technique can be employed safely and effectively in less time and is associated with a relatively short learning curve, which could encourage the widespread use of prophylactic laparoscopic gastropexy.

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.

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).

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.

Evaluation of a staged technique of immediate decompressive and delayed surgical treatment for gastric dilatation-volvulus in dogs.

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.

Colonic torsion in 4 Great Danes.

OBJECTIVE: To describe 4 Great Danes with colonic torsions and describe the risk of torsion recurrence in this breed, which has not previously been reported. This study also describes pneumocolon as a rapid and noninvasive diagnostic for confirmation of colonic torsion. SERIES SUMMARY: Four Great Danes were presented with nonspecific gastrointestinal (GI) clinical signs. Colonic torsion was diagnosed in each case with either plain radiography identifying pneumocolon or contrast radiography (barium enema). Bloodwork in each case revealed nonspecific changes. Each case had a previous gastropexy, 3 of which were prophylactic and 1 as a surgical emergency for gastric dilatation-volvulus. Three cases had favorable outcomes with emergency surgical intervention and returned to normal activity levels with resolution of clinical signs. Two cases of colonic torsion recurred, 1 of which occurred subsequent to a prior left-sided colopexy. One case of recurrence had persistent clinical signs following surgical revision and was euthanized. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report describing pneumocolon to identify a colonic torsion, providing a rapid and low-morbidity diagnostic aid and to describe the recurrence of colonic torsion in 2 dogs. Support to a previous hypothesis for an association between colonic torsion and altered GI motility is provided. Prior publications reporting colonic torsion and entrapment in German Shepherd Dogs associated with disruption of the duodenocolic ligament reported no recurrence following correction without colopexy. The recurrence in these 2 dogs suggests colonic torsion in Great Danes may represent a different or more severe form of this condition.

Biomechanical evaluation of an absorbable fixation strap for use in total laparoscopic gastropexy in dogs.

OBJECTIVE: To compare load-to-failure results for laparoscopic absorbable fixation straps (AFSs) deployed at various angles and for AFSs versus absorbable knotless (barbed) suture when used in simulated total laparoscopic gastropexy (TLG) in specimens from cadaveric dogs. SAMPLE: 30 stomach and abdominal body wall specimens. PROCEDURES: Specimens were assigned to 1 of 3 groups for use in simulated TLG constructs for comparisons of load-to-failure results for single AFSs deployed at 30°, 60°, or 90° (AFS-angle group; n = 10) or for a gastropexy span of 4 to 5 cm achieved with 3-0 absorbable knotless (barbed) monofilament suture applied in a simple continuous pattern (TLG-1; 10) versus 8 AFSs applied with a deployment angle > 30° (TLG-2; 10). A 1-way ANOVA was used to compare results among AFS deployment angles (30°, 60°, or 90°) and between TLG-1 and TLG-2. RESULTS: Mean ± SD load to failure for the AFS-angle group was significantly higher for the AFS deployment angles of 60° (8.00 ± 3.90 N) and 90° (12.71 ± 8.00 N), compared with 30° (5.17 ± 1.90 N). However, no substantial difference was detected in the mean ± SD load to failure for TLG-1 (39.18 ± 7.1 N) versus TLG-2 (31.43 ± 10.86 N). CONCLUSIONS AND CLINICAL RELEVANCE: Results of the present study supported the potential use of AFSs in gastropexy in dogs; however, prospective clinical research with adequate long-term follow-up is warranted before recommendations can be made.

Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy versus combined laparoscopic ovariectomy and total laparoscopic gastropexy: A comparison of surgical time, complications and postoperative pain in dogs.

The trend in laparoscopy is to develop easy and rapid techniques associated with reduced intraoperative complications and decreased postoperative pain. The aim of this study was to compare combined laparoscopic ovariectomy (OIE) and laparoscopic-assisted incisional gastropexy (LAG) with combined laparoscopic OIE and total laparoscopic gastropexy (TLG) for surgical time, incidence of complications and postoperative pain. Twenty-eight female dogs were randomly assigned to the LAG group (n = 14) or the TLG group (n = 14). All laparoscopic procedures were performed using a three-port technique. The gastropexy was located 3 cm caudal to the 13th rib and 4 cm lateral to the rectus abdominis muscle. Surgical time (minutes [min]), intraoperative complications and postoperative complications were recorded. The Glasgow pain score (GPS) (short form) was calculated before surgery and at 1, 6, 12, 18 and 24 hr after extubation. Surgical time was significantly longer in the TLG group (48 ± 2 min) compared with the LAG group (39 ± 2 min). Minor postoperative complications occurred in both groups and included swelling (n = 2) and subcutaneous emphysema (n = 1). No significant differences regarding the GPS were recorded between groups. The GPS was significantly higher in both groups at 1 hr and 6 hr than before surgery. Two dogs in each group required rescue analgesia. Combined laparoscopic OIE and TLG require more time to perform than combined laparoscopic OIE and LAG. Neither procedure results in significant surgical complications. Postoperative pain for 24 hr was mild and comparable in both groups.

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.

Biomechanical comparison of two percutaneous gastropexy techniques for securing percutaneous endoscopic gastrostomy tubes in canine cadavers.

OBJECTIVE: To biomechanically assess outcomes for 2 percutaneous gastropexy techniques and determine the amount of time necessary to perform the techniques for securing percutaneous endoscopic gastrostomy (PEG) tubes in canine cadavers. ANIMALS: 18 canine cadavers. PROCEDURES: 6 cadavers were assigned to each of 3 groups (PEG tube only, PEG tube with T-fastener gastropexy, and PEG tube with U-stitch gastropexy). Time to completion of placement of a PEG tube and gastropexy was recorded. After tubes were placed, the stomach and body wall on the left side of the abdomen were removed and biomechanically tested. Maximum tension at the time of initial failure of the PEG tube or gastropexy was recorded. RESULTS: Significantly more force was required to induce failure for the T-fastener and U-stitch techniques than for the PEG tube only technique. In addition, both the T-fastener and U-stitch techniques required significantly more time for placement than did the PEG tube only technique. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that performing a T-fastener or U-stitch gastropexy may decrease the risk of early dislodgement of a PEG tube in dogs. However, studies conducted with these techniques in live dogs would be necessary to confirm this hypothesis. The additional amount of time needed to perform the T-fastener or U-stitch gastropexy would likely be clinically unimportant.

Evaluation of a novel technique involving ultrasound-guided, temporary, percutaneous gastropexy and gastrostomy catheter placement for providing sustained gastric decompression in dogs with gastric dilatation-volvulus.

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.