Laparoscopic-assisted and laparoscopic prophylactic gastropexy: indications and techniques.

Gastric dilatation–volvulus (GDV) is a syndrome characterized by rapid accumulation of gas or food in the stomach, increased intragastric pressure and wall tension, and rotation of the stomach about its long axis. Gastric distention unleashes a series of potentially lethal pathophysiologic events, the most important of which are compression of the portal and caudal vena caval venous blood flow, gastric necrosis, tissue acidosis, cardiac arrhythmia, disseminated intravascular coagulation, and hypotensive and cardiogenic shock. For dogs that develop GDV, surgical correction is strongly recommended. Among those dogs, mortality remains high (15% to 33%), even with aggressive resuscitative management. A gastropexy is the creation of a permanent adhesion between the gastric antrum and the adjacent right body wall. Failure to perform a gastropexy at the time of surgery for GDV correction results in a >50% recurrence rate, whereas performing a prophylactic gastropexy during corrective surgery for GDV decreases the recurrence rate by 4% to 10%. As a result, gastropexy is now considered the standard of care. Several open surgical gastropexy techniques have been described: tube, circumcostal, belt loop, muscular flap, gastrocolopexy, and incisional. Because of the high mortality rate associated with the development of GDV, these procedures may be used prophylactically in dogs that have not had GDV but are considered to be at high risk. Studies have indicated that a prophylactic gastropexy can result in a twofold to 30-fold reduction in lifetime mortality associated with GDV for rottweilers and Great Danes, respectively. Recent advances in veterinary medicine have included a move toward more miniRisk Factors for Gastric Dilatation–Volvulus Page 60