Today's Veterinary Practice

JUL-AUG 2017

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

Issue link: http://todaysveterinarypractice.epubxp.com/i/840151

Contents of this Issue

Navigation

Page 49 of 79

48 GASTRIC DILATATION AND VOLVULUS PEER REVIEWED located caudal to the last rib to prevent penetration of the diaphragm and subsequent pneumothorax. The incision should be located dorsal enough to be in an anatomic position, as well as to avoid interference with abdominal closure or decrease risk for inadvertent damage to the stomach if future laparotomy is performed. Next, an incision of similar length is made in the seromuscular layer of the stomach at the level of the pyloric antrum. A location on the stomach without visible vasculature is chosen. Figure 3 demonstrates the completed incision and the ability to appreciate the difference between the seromuscular layer and the underlying mucosa/submucosal layer. Two rows of sutures are placed, typically in simple continuous fashion, beginning at the craniodorsal aspect of the respective incisions, as demonstrated in Figure 4 . The deep edge of the transversus abdominis incision is sutured to the deep edge of the gastric seromuscular incision, with care taken to make wide bites (at least 3 mm) on each side. Typical suture choice is a 2-0 monofilament long-lasting absorbable suture material. After completion of the first suture line, a second suture line is performed in identical fashion to oppose the superficial or ventral aspect of the respective incisions. The completed gastropexy is shown in Figure 5 . RECURRENCE Without gastropexy, the rate of recurrence of GDV is 55% to 75%, and median survival times are significantly shorter than for patients treated surgically. 10,21,25 Therefore, surgery should always be recommended. In two studies, 26,27 the rate of recurrence of GDV after gastropexy was 0%, but recurrence has been documented rarely. 10,28 Occurrence of gastric dilatation after gastropexy is reported as 5% to 11%. 21,25–27 POSTOPERATIVE TREATMENT Postoperative treatment is typically a continuum of care from pre- and intraoperative therapy. Continued volume resuscitation may include IV isotonic crystalloids (90–120 mL/kg/day); colloids, such as hydroxyethyl starch (10–30 mL/kg/day); and fresh frozen plasma or other blood products, depending on individual patient needs. For analgesia, injectable opioids are recommended. Nonsteroidal FIGURE 4. In these images, the cranial aspect of the dog is oriented to the right, and the surgeon is standing on the left side of the dog to improve visualization and ease of suturing. In A, the suturing is started with the dorsal (deep) side of the respective incisions; suturing in a cranial-to-caudal direction is most efficient for a right- handed surgeon. In B, the dorsal (deep) side of the gastric seromuscular incision is sutured to the dorsal side of the transversus abdominus incision. Assistants standing on the dog's right side can help improve visualization by retracting the abdominal wall with towel clamps and pushing in to provide tension on the body wall. A B FIGURE 3. The second step during right incisional gastropexy is an incision through the seromuscular layer of the stomach, at the level of the pyloric antrum. The incision can be made longitudinally (depicted) or transversely, taking care to avoid the prominent vasculature along the omental attachment to the stomach. In this image, the cranial aspect of the dog is oriented to the right and the underlying mucosal/submucosal layer of the stomach is differentiated with a forceps.

Articles in this issue

Archives of this issue

view archives of Today's Veterinary Practice - JUL-AUG 2017