Evaluation of percutaneous gastrostomy as a technique for permanent gastropexy

Characteristics and long-term outcomes of dogs with gastroesophageal intussusception

OBJECTIVE

To determine long-term outcomes and factors associated with those outcomes in dogs with gastroesophageal intussusception (GEI).

ANIMALS

36 dogs with GEI evaluated at 16 veterinary hospitals from January 2000 through January 2018.

PROCEDURES

Medical records of included dogs were reviewed to collect information regarding signalment, clinical signs, physical examination findings, blood work and diagnostic imaging results, surgical findings, and outcome. Factors were evaluated for associations with various outcomes.

RESULTS

Median age of dogs with GEI was 13.2 months, and males (72% [26/36]) and German Shepherd Dogs (33% [12/36]) were most common. Vomiting (67% [24/36]) and regurgitation (33% [12/36]) were the most common clinical signs. Ten of 36 (28%) dogs were euthanized without treatment, and 26 (72%) underwent treatment (25 surgically and 1 endoscopically). Twenty-three of the 26 (88%) treated dogs survived to discharge; median survival time was 995 days. At last follow-up, 15 of the 23 (65%) surviving dogs remained alive and 8 (35%) had died for reasons related to persistent regurgitation (n = 6) or reasons unrelated to GEI (2). Of the 10 dogs for which owners were contacted, 7 had persistent regurgitation, the severity of which was reduced through managed feedings. Dogs with acute (≤ 7 days) clinical signs or a previous diagnosis of megaesophagus were more likely to have persistent regurgitation than were dogs without these factors.

CONCLUSIONS AND CLINICAL RELEVANCE

Treatment should be considered for dogs with GEI given the high rate of survival to discharge and median survival time. Although persistent regurgitation was common after treatment, a satisfactory outcome was possible with medical management, including managed feedings and medications.

Percutaneous radiologically guided gastrostomy tubes: Procedural description and biomechanical comparison in a canine model

OBJECTIVE

To describe the novel placement of percutaneous radiologically guided gastrostomy (PRG) tubes in a canine cadaveric model and to biomechanically compare PRG and percutaneous endoscopic gastrostomy (PEG) tube constructs.

STUDY DESIGN

Descriptive and biomechanical experimental study.

ANIMALS

Fifteen large breed (>25 kg) canine cadavers.

METHODS

Percutaneous endoscopic gastrostomy tubes, low-profile PRG tubes, and standard PRG tubes were each placed in five canine cadavers. Body wall and stomach (with attached gastrostomy tube constructs) were harvested and biomechanically tested. Data regarding the maximal load to failure and procedure time were statistically analyzed.

RESULTS

Percutaneous endoscopic gastrostomy and PRG tube placement was successful in all cadavers with no procedure-related complications. Gastrostomy tube placement time was longer for the PEG group vs the low-profile PRG (P = .005) and standard PRG (P = .037) groups. Peak construct strength was lower for the PEG group vs the low-profile PRG (P = .002) and standard PRG (P = .010) groups. The site of failure varied among groups.

CONCLUSION

Percutaneous radiologically guided gastrostomy tubes were successfully placed in all cases with shorter placement time and greater peak construct strength compared with PEG tubes.

CLINICAL SIGNIFICANCE

Due to the increased load to failure as well as decreased placement time recorded for PRG tubes relative to PEG tubes, PRG tubes may be considered as an alternative minimally invasive gastrostomy option in large breed canine patients. Further evaluation in clinical animals is required. Results of this work were presented at the 2019 American College of Veterinary Surgeons Surgery Summit; October 16-19, 2019; Las Vegas, Nevada.

A Prospective Evaluation of a Modified Belt-Loop Gastropexy in 100 Dogs with Gastric Dilatation-Volvulus

Gastropexy is a surgical technique performed to prevent and decrease the recurrence rate of gastric dilatation and volvulus (GDV). The objective of this prospective, a descriptive cohort study on 100 client-owned dogs who were presented with GDV, is to describe a modified belt-loop gastropexy and determine its intraoperative complications and long-term efficacy. The transversus abdominis muscle was used to make an oblique belt-loop. A seromuscular antral fold, instead of a seromuscular antral flap, was passed through the belt-loop, and then, the passed portion of the antral fold was sutured to the dissected edge of the abdominal wall. Intraoperative complications related to gastropexy were recorded, and the incidence of GDV recurrence was determined a minimum of 1 yr postoperatively via telephone with the referring veterinarians and the owners. There were no intraoperative complications related to the modified belt-loop gastropexy technique. Based on follow-up conversations, none of the dogs presented signs of GDV recurrence during the follow-up period. Based on the results, there is strong clinical evidence that a modified belt-loop gastropexy prevents recurrence of GDV in dogs surviving an acute episode.

Effect of Laparoscopic-assisted Gastropexy on Gastrointestinal Transit Time in Dogs

Background

Prophylactic gastropexy has been promoted as a means of preventing gastric volvulus during gastric dilatation and volvulus (GDV) syndrome. Little is known about the impact of gastropexy on gastrointestinal transit time.

Hypothesis

Laparoscopic‐assisted gastropexy (LAG) will not alter gastrointestinal transit times when comparing gastric (GET), small and large bowel (SLBTT), and whole gut transit times (TTT) before and after surgery.

Animals

10 healthy client‐owned large‐breed dogs.

Methods

Prospective clinical trial. Before surgery, all dogs underwent physical examination and diagnostic evaluation to ensure normal health status. Dogs were fed a prescription diet for 6 weeks before determination of gastrointestinal transit with a wireless motility capsule. LAG was then performed, and dogs were fed the diet for 6 additional weeks. Measurement of transit times was repeated 6 weeks after surgery.

Results

Ten dogs of various breeds at‐risk for GDV were enrolled. No complications were encountered associated with surgery or capsule administration. There were no significant differences in GET 429 [306–1,370] versus 541 [326–1,298] (P = 0.80), SLBTT 1,243 [841–3,070] versus 1,540 [756–2,623] (P = 0.72), or TTT 1,971 [1,205–3,469] versus 1,792 [1,234–3,343] minutes (median, range) (P = 0.65) before and after LAG.

Conclusions and Clinical Importance

An effect of LAG on gastrointestinal transit time was not identified, and wireless motility capsule can be safely administered in dogs after LAG.

Description and Biomechanical Comparison of a Percutaneous Radiologic Gastropexy Technique in a Canine Cadaver Model

OBJECTIVE

To describe a novel percutaneous radiologic gastropexy (PRG) technique in a canine model and to biomechanically compare this technique to open incisional gastropexy (OIG) and laparoscopic-assisted incisional gastropexy (LAG).

STUDY DESIGN

Randomized ex vivo biomechanical study.

ANIMALS

Canine cadavers.

METHODS

Fifteen cadavers were randomized to 1 of 3 surgical interventions: OIG, LAG, and PRG. For the PRG procedure, the stomach was distended with air, and a preloaded T-fastener device was utilized to attach the stomach to the body wall with fluoroscopic-guidance. The procedural times of the 3 techniques were recorded. After completion of the procedure, the stomach and body wall overlying the stomach wall were harvested and the maximum tensile strength of the gastropexies was determined.

RESULTS

The maximal tensile strength was not significantly different between groups. The total procedural time for the PRG procedure (5 minutes) was significantly shorter than both OIG (28 minutes) and LAG (20 minutes) procedures.

CONCLUSION

The PRG technique described in this study demonstrated a similar maximal tensile strength to commonly employed gastropexy techniques (OIG and LAG) in an acute canine model. Additionally, the PRG procedure was significantly faster to perform. The clinical relevance of this technique will be determined by further study to assess the applicability and efficacy of this procedure in clinical patients by determining the likelihood of adhesion development and the ability of the adhesion to prevent gastric volvulus.

Incisional colopexy for treatment of chronic, recurrent colocloacal prolapse in a sulphur-crested cockatoo (Cacatua galerita)

OBJECTIVE

To report a surgical technique for treatment of chronic, recurrent cloacal prolapse in a sulphur-crested cockatoo (Cacatua galerita).

STUDY DESIGN

Clinical report

ANIMALS

Sulphur-crested cockatoo (n = 1) METHODS: The bird was admitted with a 2-year history of periodic lethargy, decreased appetite, dyschezia, tenesmus, and colocloacal prolapse. An incisional colopexy was performed under general anesthesia to permanently reduce the colocloacal prolapse. To gain access to the coelomic cavity, a ventral U-shaped incision was made, after which the colon and cloaca were restored in their normal anatomic position. Subsequently, the distal colon was sutured to the left abdominal wall.

RESULTS

Colocloacal prolapse was successfully reduced. One month later, cloacoplasty was performed to reduce cloacal width. Long-term follow-up, including a barium contrast study, revealed normal function and an intact colopexy, without recurrence of the prolapse.

CONCLUSIONS

Incisional colopexy is feasible despite a bird's relative small body size.

Efficacy of Incisional Gastropexy for Prevention of GDV in Dogs

Incisional gastropexy (IG) is routinely performed as either a prophylactic procedure to prevent occurrence of gastric dilatation-volvulus (GDV) or at the time of surgical correction of GDV to prevent recurrence. Despite its common use, the long-term efficacy of the IG procedure has not been reported. The hypothesis of this study was that IG performed either during surgical treatment of GDV or as a prophylactic measure would effectively prevent GDV. Medical records of 61 dogs undergoing IG following either gastric derotation for treatment of GDV or as a prophylactic procedure were evaluated retrospectively. Median follow-up time for all dogs was 717 days (range, 49–2,511 days). Of the 61 dogs, 27 had prophylactic IG performed. The remaining 34 dogs presented for GDV and had an IG performed during surgical treatment of GDV. No dog experienced GDV after IG. Recurrence of gastric dilatation (GD) alone was noted in 3 of 34 patients (8.8%) undergoing IG during surgery for GDV and in 3 of 27 patients (11.1%) treated prophylactically with IG. This study confirmed the efficacy of IG for the long-term prevention of GDV in dogs.

Clinical evaluation of a right-sided prophylactic gastropexy via a grid approach

A new technique is described for a prophylactic incisional gastropexy via a right-sided grid approach (i.e., minilaparotomy). A pilot study showed comparable tensile strength between a traditional ventral midline approach and the grid approach. Six client-owned dogs were selected for the procedure. Four weeks postoperatively, a barium gastrogram was performed to assess stomach/gastropexy position. Complications included a seroma and postoperative discomfort. This technique should be considered for any at-risk breed that is not overweight. The right-sided grid approach to a prophylactic gastropexy was less invasive than a ventral midline approach and resulted in a stable gastropexy at 4 weeks postoperatively in five of six dogs.

Prospective evaluation of laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation

OBJECTIVE

To determine long-term outcome associated with laparoscopic-assisted gastropexy in prevention of gastric dilatation-volvulus (GDV) in susceptible dogs and to evaluate use of laparoscopy to correct GDV.

DESIGN

Prospective study.

ANIMALS

25 client-owned large-breed dogs.

PROCEDURE

23 dogs susceptible to GDV were referred as candidates for elective gastropexy. These dogs had a history of treatment for gastric dilatation, clinical signs of gastric dilatation, or family members with gastric dilatation. Laparoscopic-assisted gastropexy was performed. One year after surgery, abdominal ultrasonography was performed to evaluate the attachment of the stomach to the abdominal wall. Two dogs with GDV were also treated with laparoscopic-assisted derotation of the stomach and gastropexy.

RESULTS

None of the dogs developed GDV during the year after gastropexy, and all 20 dogs examined ultrasonographically had an intact attachment. Another dog was euthanatized at 11.5 months for unrelated problems. Two dogs with GDV successfully underwent laparoscopic-assisted gastropexy after the stomach was repositioned.

CONCLUSIONS AND CLINICAL RELEVANCE

Laparoscopic-assisted gastropexy resulted in a persisting attachment between the stomach and abdominal wall, an absence of GDV development, and few complications. Dogs with a high probability for development of GDV should be considered candidates for minimally invasive gastropexy. Carefully selected dogs with GDV can be treated laparoscopically.

A rapid and strong laparoscopic-assisted gastropexy in dogs

OBJECTIVE

To develop a technique for laparoscopic gastropexy in dogs and evaluate effects on stomach position and strength of the adhesion between the stomach and abdominal wall.

ANIMALS

8 healthy dogs.

PROCEDURE

Dogs were anesthetized, and the abdomen was insufflated with carbon dioxide. A laparoscope was placed through a cannula inserted on the abdominal midline caudal to the umbilicus. Babcock forceps placed through a cannula inserted lateral to the right margin of the rectus abdominus muscle were used to exteriorize the pyloric antrum, a longitudinal incision was made through the serosa and muscular layer of the pyloric antrum, and the seromuscular layer of the pyloric antrum was sutured to the transversus abdominus muscle. After surgery, positive-contrast gastrography was used to evaluate stomach position and the onset of gastric emptying, and ultrasonography was used to assess stomach wall activity and mobility. Dogs were euthanatized 1 month after surgery, and tensile strength of the adhesion was tested.

RESULTS

In all dogs, stomach position and the onset of gastric emptying were normal 25 days after surgery, and the pyloric antrum was firmly attached to the abdominal wall 30 days after surgery. Mean +/- SD ultimate load of the adhesion in tension was 106.5 +/- 45.6 N.

CONCLUSIONS AND CLINICAL RELEVANCE

The laparoscopic gastropexy technique described in the present study could be performed quickly and easily by an experienced surgeon, resulted in a strong fibrous adhesion between the stomach and abdominal wall, and appeared to cause minimal stress to the dogs.

Gastrointestinal emergencies

The animal with a surgical gastrointestinal emergency usually requires a rapid, thorough physical examination with concurrent resuscitation. As the diagnosis is being made, the animal must be made as stable as possible before undergoing general anesthesia. During surgery, there must be a critical evaluation of gastrointestinal viability and the use of precise technical skills to achieve the best outcome. Adept postoperative management, including careful monitoring and an index of suspicion for potential complications, is vital.