Does Fixation of the Gastric Conduit Reduce the Incidence of Gastric Volvulus After Esophagectomy?

BACKGROUND

Acute volvulus of the gastric conduit is a rare complication after esophagectomy that warrants surgical intervention and is associated with increased morbidity and mortality. The aim of the study is to evaluate whether fixation of the gastric conduit would reduce the incidence of postoperative volvulus following esophagectomy.

METHODS

This single-center retrospective analysis of patients who underwent esophagectomy was conducted to determine the incidence of acute postoperative volvulus following a change in practice. All patients who underwent an esophagectomy from September 2013 to November 2022 were included. We compared postoperative outcomes of gastric conduit volvulus, reoperations, morbidity, and mortality among those who had fixation versus non-fixation of the conduit to the right pleural edge.

RESULTS

Two hundred and forty-two consecutive patients underwent minimally invasive esophagectomy (81% male, 41% were < 67 years old). The first 121 (50%) patients did not undergo fixation of the gastric conduit, while the subsequent 121 (50%) patients did undergo fixation. Comparing both groups, there were no significant differences in major complications, anastomotic leak, and 30-day and 90-day all-cause mortality. Four (2%) patients developed gastric conduit volvulus in the non-fixation group, requiring reoperative intervention. Following implementation of fixation, no patient experienced gastric volvulus.

CONCLUSION

Acute volvulus of the gastric conduit is a rare complication after esophagectomy. Early diagnosis and surgical intervention are critical. In this study, although not statistically significant, fixation of the gastric conduit did reduce the number of patients who experienced postoperative volvulus. Additional future studies are needed to validate this technique and the prevention of postoperative acute gastric conduit volvulus among a diverse patient population.

Incidence of gastric dilatation-volvulus following a splenectomy in 238 dogs

There is contradicting information in the veterinary literature regarding canine splenectomy and the increased risk for subsequent gastric dilatation-volvulus. The main purpose of this study was to determine the rate of occurrence of gastric dilatation-volvulus following splenectomy in medium to large breed dogs compared with a control group undergoing other abdominal procedures. Follow-up was performed by reviewing the medical records and conducting phone interviews. Weight, gender, and presence of a hemoabdomen at the time of surgery were not significantly associated with occurrence of gastric dilatation-volvulus, while increasing age was. Ten of 238 (4%) dogs in the splenectomy group and 3/209 (1.4%) dogs in the control group subsequently developed gastric dilatation-volvulus, which was not significantly different (P = 0.08). While the findings approach significance and support a need for future investigation, the current recommendation for gastropexy at time of splenic removal should be made on a case by case basis and while considering previously documented risk factors.

Nutritional risks to large-breed dogs: from weaning to the geriatric years

Distinctive risk factors for disease are identifiable throughout life stages of large- and giant-breed dogs. From weaning to maturity, improper nutrition is linked to developmental skeletal diseases. As large dogs mature, skeletal diseases and obesity can lead to osteoarthritis. These dogs are difficult to manage when orthopedic or osteoarthritic disease affects mobility and quality of life, thereby increasing the risk of early death. Gastric dilatation and volvulus is another disease that is leading cause of death in large- and giant-breed dogs. Management of health, including proper nutrition, exercise, and weight control, provides the best opportunity for successful aging of large- and giant-breed dogs.

The Effect of Ingredients in Dry Dog Foods on the Risk of Gastric Dilatation-Volvulus in Dogs

Using dry dog food label information, the hypothesis was tested that the risk of gastric dilatation-volvulus (GDV) increases with an increasing number of soy and cereal ingredients and a decreasing number of animal-protein ingredients among the first four ingredients. A nested case-control study was conducted with 85 GDV cases and 194 controls consuming a single brand and variety of dry food. Neither an increasing number of animal-protein ingredients (P=0.79) nor an increasing number of soy and cereal ingredients (P=0.83) among the first four ingredients significantly influenced GDV risk. An unexpected finding was that dry foods containing an oil or fat ingredient (e.g., sunflower oil, animal fat) among the first four ingredients were associated with a significant (P=0.01), 2.4-fold increased risk of GDV. These findings suggest that the feeding of dry dog foods that list oils or fats among the first four label ingredients predispose a high-risk dog to GDV.

Gastric volvulus in children

PURPOSE

The aim of the study was to review the records of all children who presented with gastric volvulus in the past 10 years.

METHODS

The study group consisted of 21 children with an age range from 0.2 months to 4.3 years who were operated for gastric volvulus from 1992 to 2003.

RESULTS

Initial symptoms included acute abdominal pain after meals, vomiting, and in 8 cases, acute apnea associated with pallor, cyanosis, and hypotonia. After the first episode, barium studies revealed an organoaxial gastric volvulus in all cases. The surgical procedure was an anterior gastropexy with reinforcement of the esophagogastric angle performed by laparoscopy in 13 cases and by laparotomy in 8 (1 converted laparoscopy). An associated antireflux fundoplication was done in 3 patients. All children received postoperative antireflux medication for at least 1 month. The follow-up ranged from 4 months to 4.8 years. Two children in the laparotomy group required reoperation (Toupet fundoplication) for persistent gastroesophageal reflux disease. All children are currently symptom-free and without treatment.

CONCLUSIONS

Gastric volvulus is a clinical and radiological reality, which can be treated by a gastropexy. Initial fundoplication is not mandatory. The laparoscopic gastropexy is a good option and allows a repeat laparoscopic procedure if needed.

Climatic conditions as a risk factor in canine gastric dilatation-volvulus

Canine acute gastric dilatation-volvulus (GDV) is a life-threatening condition of multifactorial origin. The risk of developing GDV is influenced by a variety of factors, including breed, age, gender, temperament, diet and management. A relationship between seasonal variations and the frequency of GDV has been previously documented although no association was found with any specific climatic event. Variables in weather conditions within a defined geographic region were investigated in a retrospective study of 287 client-owned dogs diagnosed with GDV between 1992 and 1999. Monthly incidences were evaluated and differences in atmospheric temperature, humidity and pressure between days in which GDV cases were observed and days in which no case was presented were examined. Although temperature was significantly associated with the occurrence of GDV, the difference in temperatures between days with and days without GDV cases was so small that it is unlikely to be of clinical relevance. Moreover, no significant association was found between GDV occurrence and atmospheric pressure or humidity, and a seasonal variation in GDV incidence was not observed.

Prevalence of endotoxemia in healthy postparturient dairy cows and cows with abomasal volvulus or left displaced abomasum

Left displaced abomasum (LDA) and abomasal volvulus (AV) occur most commonly in postparturient dairy cows. Our main hypothesis was that endotoxemia occurred more frequently in the peripheral blood of cows with LDA or AV than in healthy cows because increased luminal pressure in AV or LDA, or the presence of a hemorrhagic strangulating obstruction in AV, may have injured the abomasal mucosa, thereby facilitating translocation of luminal endotoxin into the circulation. Therefore, our main objective was to compare the prevalence and magnitude of endotoxemia in healthy postparturient cows with the prevalence and magnitude of endotoxemia in cows with AV and LDA. We examined 60 adult dairy cows in early lactation that were diagnosed with AV (n = 15) or LDA (n = 15) or were healthy on physical examination (control group, n = 30). Jugular venous blood was obtained from cows in all 3 groups, and right gastroepiploic venous blood was obtained during surgical correction of AV and LDA immediately after repositioning of the abomasum. Platelet-rich plasma endotoxin concentrations were measured with a chromogenic limulus amoebocyte lysate assay. Endotoxin was detected in jugular vein plasma in 50% (15/30) of control cows; however, the prevalence of endotoxemia was significantly lower (P < .05) in cows with AV (7%, 1/15) or LDA (20%, 3/15). Endotoxin was detected simultaneously in right gastroepiploic and jugular vein plasma in only 1 cow with LDA and 0 cows with AV. Contrary to our hypothesis, we conclude that endotoxemia is infrequently present in postparturient dairy cows with AV or LDA.

Intra-abdominal Sepsis in Elderly Persons

Elderly patients represent a greater percentage of the population now than ever before, with 12.4% of North Americans being >65 years of age. Intra-abdominal illnesses in this population often have different etiologies than those seen in younger populations. Because of a variety of physiologic changes that occur as people age, elderly persons have different sites of infection, may present with vague symptoms and longer histories, are more gravely ill, and, overall, have worse prognoses. The major causes of intra-abdominal sepsis in elderly persons are reviewed, explanations for the differences in presentation and prognosis are offered, and the treatments of each cause are reviewed.

An unusual case of gastric volvulus after laparoscopic paraesophageal hernia repair

Laparoscopic surgery for paraesophageal hernia is well accepted. However, the complications of this relatively new procedure have not been thoroughly investigated. Only four cases of recurrent volvulus after paraesophageal hernia repair have been reported. A 52-year-old man presented with a large right-side paraesophageal hernia. He experienced a retroperitoneal midgastric volvulus despite correct orientation of the stomach distally and proximally. We report an unusual complication that seems congenital in origin. Diagnostic and corrective measures are suggested.

Incidence of and breed-related risk factors for gastric dilatation-volvulus in dogs

OBJECTIVE

To compare incidence of and breed-related risk factors for gastric dilatation-volvulus (GDV) among 11 dog breeds (Akita, Bloodhound, Collie, Great Dane, Irish Setter, Irish Wolfhound, Newfoundland, Rottweiler, Saint Bernard, Standard Poodle, and Weimaraner).

DESIGN

Prospective cohort study.

ANIMALS

1,914 dogs.

PROCEDURE

Owners of dogs that did not have a history of GDV were recruited at dog shows, and the dog's length and height and depth and width of the thorax and abdomen were measured. Information concerning the dogs' medical history, genetic background, personality, and diet was obtained from owners, and owners were contacted by mail and telephone at approximately 1-year intervals to determine whether dogs had developed GDV or died. Incidence of GDV based on the number of dog-years at risk was calculated for each breed, and breed-related risk factors were identified.

RESULTS AND CLINICAL RELEVANCE

Incidence of GDV for the 7 large (23 to 45 kg [50 to 99 lb]) and 4 giant (> 45 kg [> 99 lb]) breeds was 23 and 26 cases/1,000 dog-years at risk, respectively. Of the 105 dogs that developed GDV, 30 (28.6%) died. Incidence of GDV increased with increasing age. Cumulative incidence of GDV was 5.7% for all breeds. The only breed-specific characteristic significantly associated with a decreased incidence of GDV was an owner-perceived personality trait of happiness.

Small size of food particles and age as risk factors for gastric dilatation volvulus in great danes

A case-control study was conducted to investigate whether age, gender, neuter status, type of food, feeding frequency, food intake time, interval between feeding and exercise, duration of exercise and overall physical activity were risk factors for gastric dilatation volvulus (GDV) in the great dane. The sample population consisted of 38 great danes with acute GDV (cases) and 71 great danes owned by members of the Dutch Great Dane Association (controls). Information on the risk factors was collected by using clinical data in combination with a questionnaire, and the data were analysed by backward stepwise conditional logistic regression analysis. Dogs fed a diet containing particles of food > 30 mm in size (kibble and/or dinner and/or home-prepared food with large pieces of meat) had a lower risk of GDV than dogs fed a diet containing only particles < 30 mm in size (kibble or dinner and/or canned meat and/or home-prepared food cut into small pieces or ground in a food processor). Increasing age was also a risk factor for GDV. Gender, neuter status, feeding frequency, food intake time, the interval between feeding and exercise, the duration of exercise, and overall physical activity were not identified as risk factors. Feeding a diet including large pieces of meat may help to reduce the incidence of GDV in great danes.

Pneumonyssoides caninum infection--a risk factor for gastric dilatation-volvulus in dogs

The pathophysiology, clinical course and therapeutic management of gastric dilatation-volvulus (GDV) in dogs are well known. However, the aetiology remains elusive. Aerophagia has often been put forward as a contributing cause of GDV. The most common clinical sign in dogs with nasal mite (Pneumonyssoides caninum) infection is 'reversed sneezing', which may result in aerophagia. A prospective one-year necropsy study was conducted. Of 250 dogs, 17 were GDV cases and, of these, 35% had concurrent nasal mite infection compared to 5% in the control population. Multivariate logistic regression analyses performed using the 187 dogs with complete records included nasal mite infection status, age, weight and gender. Nasal mite infection was found to be the most important risk factor for GDV in this study, with an odds ratio and confidence interval of 27.6 (4.8-157.5). Other risk factors that were marginally significant included weight and age with odds ratios of 1.08 (1.02-1.13) and 1.37 (1.04-1.79), respectively. Gender was not found to be a significant risk factor for GDV. This study suggests that nasal mite infection may contribute to the development of GDV in otherwise predisposed dogs.

Risk factors for gastric dilatation in Irish setter dogs

Questionnaires were used to obtain data about Irish setters with gastric dilatation (GD) and control Irish setters. The risk of GD increased with age (P < 0.01) but was not associated with gender. Age and gender-matched controls were compared with cases (n = 74). Predisposing risks were aerophagia (unadjusted odds ratio 12.44, P < 0.001), a single food type (adjusted odds ratio 3.15, P < 0.01) and feeding once daily (adjusted odds ratio 2.90, P < 0.02). Apparent risk from a dry food diet and a condition score of less than 2 was not confirmed by logistic regression. Precipitating risks were recent kennelling (unadjusted odds ratio 100, P < 0.005) or a car journey (unadjusted odds ratio 3.29, P < 0.025). No risk was attributed to intensity or duration of exercise, temperament, appetite, speed of eating, vomiting or diarrhoea.

Influence of thoracic conformation and genetics on the risk of gastric dilatation-volvulus in Irish setters

Body measurements, history of gastric dilatation-volvulus (GDV), and other data were obtained for 155 Irish setters at the 1994 National Specialty Show. The dogs ranged in age from 6.5 months to 12.4 years (mean+/-standard deviation [SD], 3.6+/-2.6 years); 11 (7%) of the dogs had histories of GDV. Gastric dilatation-volvulus risk increased 33% for each year of age (p of 0.01). Dogs with the deepest thorax relative to width (ratio range, 1.61 to 1.85) had a significantly greater GDV risk than those with the shallowest thorax (ratio range, 1.20 to 1.50); the odds ratio was 8.45; the 95% confidence limits were 1.44 to 49.57; and the p value equaled 0.02. Having a relative (particularly a parent) with GDV also increased GDV risk. Five-generation pedigrees yielded a significantly higher mean coefficient of relationship for the 11 dogs with GDV than for the 11 dogs without GDV.

Predisposition to gastric dilatation-volvulus in relation to genetics of thoracic conformation in Irish setters

Thoracic depth/width ratios (TDWRs) were calculated from measurements of the parents (i.e., common dam and two sires) and puppies in two litters of Irish setters. The TDWRs of the parents, distribution of TDWRs in the litters, and comparisons with earlier population studies suggest that an incompletely dominant major gene and a background of minor genes and environmental factors are responsible for the TDWR. A history of gastric dilatation-volvulus (GDV) (i.e., bloat) was correlated with high TDWRs in this family as it was for Irish setters and certain other breeds studied earlier. It may be possible to reduce the incidence of GDV by selective breeding of dogs with lower TDWRs.

Multiple risk factors for the gastric dilatation-volvulus syndrome in dogs: a practitioner/owner case-control study

A study was conducted of 101 dogs (i.e., case dogs) that had acute episodes of gastric dilatation-volvulus (GDV) and 101 dogs (i.e., control dogs) with nonGDV-related problems. The control dogs were matched individually to case dogs by breed or size, and age. Predisposing factors that significantly (p less than 0.10) increased a dog's risk of GDV were male gender, being underweight, eating one meal daily, eating rapidly, and a fearful temperament. Predisposing factors that decreased the risk of GDV significantly were a "happy" temperament and inclusion of table foods in a usual diet consisting primarily of dry dog food. The only factor that appeared to precipitate an acute episode of GDV was stress.

Analysis of risk factors for gastric dilatation and dilatation-volvulus in dogs

The Veterinary Medical Data Base was usd to conduct an epidemiologic study of gastric dilatation and dilatation-volvulus (GDV) to describe changes over time in frequency of canine hospital admissions, to identify risk factors, and to estimate their relative importance. Cases in this case-control study included 1,934 dogs with GDV that were admitted to 12 participating veterinary hospitals from 1980 to 1989. The controls were 3,868 dogs with other diagnoses that were randomly selected from the same hospitals. Frequency of GDV per 1,000 canine hospital admissions ranged from 2.9 to 6.8. The case fatality rate was 28.6 and 33.3% for gastric dilatation alone and for gastric dilatation with volvulus, respectively. Using logistic regression analysis, the odds ratio (OR) and its 95% confidence limits (95% CL) for GDV associated with purebred vs mixed-breed dogs were 2.5 and 2.1, 3.0, respectively. The risk of GDV was associated with increasing age (chi 2 = 305.6, P < 0.0001) and increasing weight (chi 2 = 627.8, P < 0.0001). Significant association of GDV risk with sex or neuter status was not found. The 5 breeds having at least 10 cases and 8 controls and with the highest risk of GDV were Great Dane (OR, 10.0; 95% CL, 6.4, 15.6), Weimaraner (OR, 4.6; 95% CL, 2.3, 9.2), Saint Bernard (OR, 4.2; 95% CL, 2.3, 7.4), Gordon Setter (OR, 4.1; 95% CL, 1.8, 9.3), and Irish Setter (OR, 3.5; 95% CL, 2.4, 5.0). The effect of increasing body weight on GDV risk was less than that of increasing ideal adult breed weight, determined by published breed standards.(ABSTRACT TRUNCATED AT 250 WORDS)

Volvulus of stomach in childhood

Six children, aged upto one year, with volvulus of the stomach are reported. Vomiting and regurgitation of feeds were the main presenting symptoms. Eventration of the left hemidiaphragm was present in four cases. Barium meal confirmed the diagnosis. Five cases were operated on through an abdominal approach. Plication of the diaphragm (3 cases), colonic displacement (2) and gastrostomy (3) were resorted to. One child needed reoperation for a missed Ladd's band. There was no operative mortality.

Epidemiology of gastric dilatation-volvulus in the military working dog program

Examination of case records of 914 military working dogs which died during the period January 1, 1987-December 31, 1989, revealed 31 deaths (3.4%) due to gastric dilatation-volvulus (GDV) or its complications. The fata episode of GDV was the only reported occurrence of this condition in 81% of the dogs. Male German shepherd dogs, 6-10 years of age, that were fed a medicated high-energy ration once per day, predominated. Dogs in this study that had a prior history of acute gastric dilatation (AGD) or GDV, and that were decompressed by non-surgical means, eventually died of GDV. A comparison with dogs surviving an AGD or GDV episode from the same time period showed most to have had surgical decompression and gastropexy.

Risk factors for abomasal volvulus and left abomasal displacement in cattle

A hospital-based case-control study was conducted to evaluate and compare risk factors for abomasal volvulus (AV) and left displaced abomasum (LDA) in cattle. Medical record abstracts were derived from 17 North American veterinary schools by the Veterinary Medical Data Program for all cattle admitted between Jan 1, 1977 and Dec 31, 1986, and for those with a diagnosis of AV or LDA. From a total of 108,956 individual cattle records, 1,036 cases of AV and 7,695 cases of LDA were identified, with a ratio of LDA to AV cases of 7.4 to 1. In-hospital mortality was 23.5% for AV and 5.6% for LDA. Age, breed, gender, and season each had significant (P less than 0.05) effects on risk for AV and LDA. Risk for AV and LDA increased with increasing age, with greater risk in cattle aged 4 to 7 years. Dairy cattle were at higher risk of developing AV (adjusted odds ratio, 36.4) and LDA (adjusted odds ratio, 95.2) than were beef cattle. The odds of AV in Brown Swiss cattle were significantly (P less than 0.0001) lower, and the odds of LDA in Guernsey cattle were significantly (P less than 0.0001) higher than those in Holstein cattle. Female cattle were also at higher risk of developing AV (adjusted odds ratio, 3.3) and LDA (adjusted odds ratio, 29.1) than were male cattle. The odds of AV and LDA varied considerably throughout the year, with the lowest number of cases observed in autumn. Seasonal development of AV differed significantly (P less than 0.0001) from that of LDA, with the odds of AV and LDA being highest in January and March, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

An ecological analysis of risk factors for postpartum disorders of Holstein-Friesian cows from thirty-two New York farms

Path analysis and multiple logistic-normal regression were used to model the interrelationships between stated herd management practices and herd 30-d postpartum incidence rates of dystocia, retained placenta, and clinical postpartum metritis, cystic ovary, milk fever, ketosis, left displaced abomasum, and mastitis. Management risk factors were obtained from a personal interview questionnaire. Data were from 2141 multiparous Holstein calvings from May 1981 through April 1982 in 32 commercial herds in the vicinity of Cornell University. Farms where the stated policy was to administer low calcium diets to the dry cows experienced more dystocia and retained placenta. More dystocia was experienced on farms where the stated policy was to administer extra vitamin D to dry cows, where dry cows were housed with the milking cows, or where calving occurred in maternity pens rather than stanchions. There was an increased likelihood of milk fever and left displaced abomasum on farms on which the stated policy was to lead feed. Farms where dairy farmers treated cases of retained placenta had more retained placenta than farms on which the treatment was done by the veterinarian. Farms reporting the practice of feeding the cows to increase their weight during the dry period had increased odds of ketosis.