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47 JULY/AUGUST 2017 ■ TVPJOURNAL.COM PEER REVIEWED ceased by the time of surgery, but if hemorrhage is ongoing, these vessels should be ligated. It is important to allow time for organs to reperfuse after gastric repositioning and before performing splenectomy or partial gastrectomy. The stomach should be palpated for any evidence of foreign material, 4 and the entire stomach, especially the greater curvature and dorsal aspect, should be carefully evaluated for necrosis. Gastric necrosis is reported in 13% to 20.5% of patients. 1,17–19 Necrotic areas can be identified by their black, grey/white, or green serosal color; thin texture on palpation; or lack of serosal capillary perfusion. If gastric necrosis is present, placement of stay sutures in visibly normal tissue helps to manipulate the stomach, plan gastric resection, and limit potential spillage of gastric contents into the abdomen. Partial gastrectomy can be performed via resection and hand-sewn 2-layer closure or by using surgical stapling equipment. All nonviable tissue should be resected; normal tissue will have bleeding from the cut surface, particularly the muscularis layer. The appearance of the mucosal tissue should not be used to guide resection. The limiting factor for the surgeon's ability to perform resection is the anatomic location of necrosis and concern for esophageal lumen diameter, specifically when necrotic areas involve the cardia and esophagus. The need for splenectomy because of irreversible vascular devitalization or thrombosis is reported in approximately 16% to 22% of patients. 17–19 A nonviable spleen has a spongy texture, lack of pulse in the splenic artery, and a black or grey color that does not improve after gastric repositioning. Splenectomy may be performed using ligation, stapling equipment, or vessel sealant devices. Right-Sided Gastropexy A gastropexy is the creation of a permanent adhesion between the stomach at the level of the pyloric antrum and the adjacent right body wall. Numerous techniques for performing right-sided gastropexy for GDV are described, including incisional, belt-loop, circumcostal, ventral incision/incorporating, stapled, tube, and laparoscopic assisted. For successful adhesion formation, the muscular layers of the body wall and the stomach should be joined. Achieving an anatomically correct gastropexy is important to prevent potential complications, such as gastric outflow obstruction. 20 No study has compared all the different techniques simultaneously; however, these techniques reportedly have similar rates of morbidity, adhesion formation, strength, and recurrence. 21–23 Technique for Right Incisional Gastropexy Right incisional gastropexy is the most commonly performed technique because of its technical ease, low risk of morbidity, no need for additional instrumentation, and effective production of a permanent adhesion. 24 The site of gastropexy is first planned by manually apposing the stomach to the body wall to ensure an anatomically appropriate site. To aid in visualization, the Balfour retractor can be removed, and assistants standing on the right side of the dog can retract the abdominal wall with towel clamps or Army-Navy retractors. The surgeon can change position at the table and stand on the dog's left side for improved access for suturing. An incision is made along the right body wall, completely through the transversus abdominis muscle. The incision can be oriented vertically or horizontally, as demonstrated in Figure 2 . It is important for the incision to be FIGURE 2. These images depict the initial step in right incisional gastropexy in 2 separate patients. The cranial aspect of each dog is oriented to the right of the photograph. An incision is made through the transversus abdominus muscle on the right body wall, caudal to the last rib to avoid incising the diaphragm and dorsal enough to maintain an anatomic position. The incision can be oriented vertically (A) or horizontally (B). A B