Clinical results and complications of preventive laparoscopic assisted gastropexy in 17 dogs: preliminary study

In terms of GDV prevention, a number of non-surgical measures are recommended. However, the only truly reliable method is gastropexy, most often as part of a surgical treatment of GDV. Gastropexy may be performed preventively either during laparotomy indicated for another reason than GDV, or newly laparoscopically, as independent preventive gastropexy. Preventive laparoscopic assisted gastropexy (PLAG) was performed in 17 patients at the Department of Surgery and Orthopaedics of the Small Animal Clinic at the University of Veterinary and Pharmaceutical Sciences in Brno. Clinical results and complications of PLAG were evaluated 3-12 months after surgery. The most frequent clinical finding of PLAG was a skinfold at the site of gastropexy immediately after the surgery (n = 8; 47%), or still on day 12 after the surgery (n = 1; 6%). As for PLAG complications, in one case a seroma formation was found at the site of gastropexy (6%); in two patients iatrogenic perforation of the splenic capsule (12%) occurred, which in one case gave reason to converting laparoscopy into laparotomy (6%). In none of the patients, death, gastropexy failure, GDV development, dehiscence, infection of or haemorrhage from the surgical wound were noted. Laparoscopic assisted gastropexy appears as a reliable and miniinvasive surgical method of GDV prevention and it may be recommended for high-risk breeds of dogs. Gastric dilatation-volvulus, stomach, miniinvasive surgery, GDV, prophylaxis Gastric dilatation-volvulus (GDV) is a life threatening disease and its mortality ranges from 10 to 60% (Aronson et al. 2000). GDV is the second most frequently stated cause of death in large breeds of dogs (Glickman et al. 1994, 2000). Precise causes and principles of the origin of the disease are still unknown; only risk factors have been identified, such as decreased stomach motility and its lengthened emptying (Greenfield et al. 1989; Hall et al. 1989; Hall 1989). In terms of “external” factors, the origin of the disease is affected by the diet, amount of feed received, manner of receiving feed, and stress (Funkquist 1979; Burrows et al. 1985; Glickman et al. 1997; Theyse et al. 1998). The most threatened by GDV are dogs of large and giant breeds, deep-chested dogs, and old and overweight individuals (Schaible et al. 1997; Glickman et al. 2000a; Glickman et al. 2000b). Specifically speaking, GDV occurs most frequently in the Great Dane, Weimaraner Pointer, German Shepherd, Saint Bernard dog, Gordon and Irish Setter (Glickman et al. 1994). It has been stated that dogs with a “happy” temperament are at a lower risk of GDV occurrence (Glickman et al. 1997). Another factor that markedly increases the risk of this disease is previous splenectomy (Millis et al. 1995). Preventive non-surgical measure recommendations for the prevention of gastric dilatation include resting before and after feeding, “checking up” the dog’s condition 2-4 h after feeding, dividing the daily feeding dose into 2-3 servings per day, selecting the optimal size of food granules etc. A large number of studies dealing with factors affecting the origin and development of GDV have been conducted (Van Kruiningen et al. 1974; Kronfeld 1979; Morgan 1982; Glickman et al. 1994, 1996, 1997, 2000; Elwood 1998) but gastric ACTA VET. BRNO 2011, 80: 093–099; doi:10.2754/avb201180010093 Address for correspondence: MVDr. Lucie Urbanová Department of Surgery and Orthopaedics Small Animal Clinic, Faculty of Veterinary Medicine University of Veterinary and Pharmaceutical Sciences Brno Palackeho 1-3, 612 42 Brno, Czech Republic Phone: +420 541 562 349 E-mail: [email protected] http://www.vfu.cz/acta-vet/actavet.htm volvulus can be prevented demonstrably only by gastropexy (Rawlings 2000). It is also the only broadly recognized method of GDV prevention (Rawlings 2000; Monnet 2003), most often as part of a proper surgical treatment of the GDV syndrome. If during the treatment of the GDV syndrome gastropexy is not performed, the risk of recurrence is around 80% (Wingfield et al. 1975; Eggertsdottir and Moe 1995; Glickman et al. 1998). A number of gastropexy methods have been described including incisional gastropexy, tube gastropexy, circumcostal gastropexy, belt-loop gastropexy, or possibly gastrocolopexy (Fossum 2007). The mentioned methods of stomach fixation differ in their strength and difficulty in performing but all of them are reliable enough (Monnet 2003). At our department, we advice preventive gastropexy to clients of predisposed dog breeds in cases when laparotomy is indicated for other reasons (e.g. ovariohysterectomy, procedures on the gastrointestinal or urinary tracts), and most frequently we perform incisional gastropexy. Preventive gastropexy should decidedly be advised for patients that have already been treated for a gastric disease accompanied with gastric tympany (Rawlings 2002). Gastric dilatation-volvulus syndrome is a disease relatively frequently occurring in practice (Glickman et al. 1994). At our department, we surgically treat around 70 cases of GDV a year. Typically, this disease has a peracute course, requiring a prompt surgical solution mostly during the night time. In the course of treatment a number of complications may occur and the GDV treatment is expensive for the owners, and therefore they sometimes require euthanasia instead of treatment. Although it is generally known that predisposition to this disease is genetically conditioned (Glickman et al. 2000), breeding clubs do not monitor this fact in any way and do not adjust to it even in the breeding of the predisposed dog breeds. Moreover, clients tend to refuse the mentioned invasive methods of gastropexy associated with a laparotomic approach as prevention of GDV, unless it is accompanied with another indication for laparotomy. Considering the above mentioned factors, in connection with introducing new miniinvasive laparoscopic techniques in small animal surgery at our department we started to perform preventive laparoscopic assisted gastropexies, either independently or in combination with ovariectomy/ovariohysterectomy. By introducing laparoscopic assisted gastropexy into common practice at the Department of Surgery and Orthopaedics of the Small Animal Clinic at the University of Veterinary and Pharmaceutical Sciences in Brno (Crha et al. 2007); new possibility has opened for reliable GDV prevention with all the advantages of a miniinvasive surgical procedure. In this article we present our experience and primary results regarding miniinvasive laparoscopic assisted gastropexy in clinical patients. Materials and Methods At the Department of Surgery and Orthopaedics of the Small Animal Clinic at the University of Veterinary and Phramaceutical Sciences in Brno, preventive laparoscopic assisted gastropexy was performed from January 2009 until September 2009 (once in combination with laparoscopic ovariectomy) in a total of 17 patients (12 males and 5 females) at the age of 9 months to 9 years and body weight of 45.8 ± 10.4 kg. The dogs were of breeds predisposed to this disease, namely 4 Great Danes, 3 Labrador Retrievers, 2 Rottweilers, 1 White Swiss Shepherd, 1 Scottish Deerhound, 1 Newfoundland Dog, 1 Dogue de Bordeaux, 1 Rhodesian Ridgeback, 1 Cane Corso, 1 German Shepherd and 1 Golden Retriever. Most patients underwent anaesthesia (or another surgical procedure) for another reason, e.g. radiological diagnostics of a developmental joint disease, tumour excision, follow-up examination after previous orthopaedic surgery, arthroscopic joint surgery, or preventive ovariectomy (also performed laparoscopically). The owners were offered the possibility of preventive gastropexy using laparoscopic assisted method during the primary examination of