ILMU BEDAH KHUSUS VETERINER

“GASTROPEXY”

Disusun Oleh :
Kelompok 1
Setio Santoso 1309005128
Baiq Indah Pratiwi 1609511001
Yoga Mahendra Pandia 1609511005
Dimas Norman Medellu 1609511013
Pieter Mbolo Maranata 1609511016
Audrey Febiannya Putri B. 1609511023
Ni Kadek Deasy Pitriyawati 1609511024
Kelas 2016 C

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN
UNIVERSITAS UDAYANA
DENPASAR
2019

i
 RINGKASAN

Gastropexy merupakan salah satu jenis prosedur pembedahan yang

termasuk ke dalam bedah sistem digesti. Gastropexy adalah suatu prosedur
pembedahan pada lambung dimana menciptakan adhesi permanen antara antrum
pilorus dan dinding abdomen kanan untuk mencegah volvulus lambung.

Kata kunci : Gastropexy, Pembedahan, Lambung

SUMMARY

Gastropexy is a type of surgical procedure that is included in the digestion

system surgery. Gastropexy is a surgical procedure on the stomach which creates
permanent adhesion between the pyloric antrum and the right abdominal wall to
prevent gastric volvulus.

Key word :Gatropexy, Surgery, Stomach

ii
 KATA PENGANTAR
Om Swastiastu,
Puja dan puji syukur penulis panjatkan kehadirat Ida Sang Hyang Widhi
Wasa/ Tuhan Yang Maha Esa karena atas asung kertha wara nugraha dan rahmat-
Nya kami dapat menyelesaikan paper individu dari mata kuliah Bedah Khusus
Veteriner yang berjudul “Gastropexy”.
Penulis mengucapkan terima kasih kepada semua pihak yang telah
membantu terselesaikanya paper ini dengan baik dan tepat pada waktunya. Penulis
menyadari bahwa paper ini masih jauh dari sempurna dalam penyajian bahasa
serta wawasan yang ada.. Maka dari itu kami mengharapkan saran demi kemajuan
dalam penulisan paper selanjutnya.
Akhir kata penulis berharap agar karya tulis ini dapat bermanfaat dalam
pengembangan ilmu pengetahuan dan bagi pihak-pihak yang memerlukan. Atas
perhatiannya, terima kasih.
Om Santih, Santih, Santih Om

Denpasar, 29 Oktober 2019

Penullis

iii
 DAFTAR ISI
HALAMAN JUDUL ................................................................................... i
RINGKASAN / SUMMARY ....................................................................... ii
KATA PENGANTAR ................................................................................. iii
DAFTAR ISI ............................................................................................... iv
DAFTAR GAMBAR ................................................................................... v
BAB I PENDAHULUAN
1.1 Latar Belakang ................................................................................. 1
1.2 Rumusan Masalah ............................................................................ 2
1.3 Tujuan Penulisan .............................................................................. 2
1.4 Manfaat Penulisan ............................................................................ 2
BAB II TINJAUAN PUSTAKA
2.1 Definisi Gastropexy .......................................................................... 3
BAB III PEMBAHASAN
3.1 Prea– Operasi ................................................................................... 5
3.2 Operasi ............................................................................................. 6
3.3 Pasca Operasi ................................................................................... 13
BAB IV PENUTUP
4.1 Kesimpulan ...................................................................................... 15
4.2 Saran ................................................................................................ 15
DAFTAR PUSTAKA .................................................................................. 16

iv
DAFTAR GAMBAR

v
 BAB I
PENDAHULUAN

1.1 Latar Belakang

Minat masyarakat akan hewan peliharaan semakin tinggi, hewan
sangat diminati untuk penjaga, hiburan, dan teman hidup. Salah satu jenis
hewan yang paling diminati oleh masyarakat adalah anjing. Anjing seringkali
dimanfaatkan oleh manusia sebagai hewan penjaga, penyelamat dan pencari
jejak yang membantu polisi, dan keahlian-keahlian lainnya yang lebih banyak
dibanding dengan hewan jenis lainnya. Namun banyak diantara anjing –
anjing kesayangan tersebut mengalami gangguan penyakit, salah satunya
adalah Gastric Dilatation Volvulus (GDV). GDV adalah suatu sindrom pada
anjing dimana lambung mengalami distensi dan berputar atau melintir atau
torsio sehingga menimbulkan perubahan patologi kompleks lokal atau
sistemik dan perubahan fisiologis. Ras anjing tertentu biasanya lebih rentan
terhadap GDV daripada ras anjing lainnya. Biasanya GDV terjadi pada ras –
ras anjing dengan dada yang dalam dan sempit, salah satunya adalah ras
Labrador Retriver.
Gastric Dilation Volvulus ( GDV ) dapat terjadi bila lambung terisi
udara dan cairan ( bloat atau gastric dilation ) dan kemudian terbalik diatas
lambung itu sendiri yang disebut volvulus atau twisting. Derajat rotasi
lambung lebih dari 180 derajat, keadaan ini menyebabkan blokade suplai
darah yang menuju limpa dan jaringan mati pada dinding lambung.GDV
biasanya berhubungan dengan makanan dalam jumlah besar yang
menyebabkan lambung membesar karena adanya makanan dan gas. Saat
lambung mulai membesar, tekanan pada lambung meningkat ini dapat
mengakibatkan hambatan sirkulasi darah dari abdomen ke jantung, shock
hypovolemia karena hilangnya aliran darah pada lapisan lambung serta
ruptura dinding lambung, shock endotoksemia dan alkalosis serta acidosis
metabolik. Posisi lambung yang meluas juga dapat menyebabkan tekanan
pada diafragma yang dapat mencegah paru - paru untuk mengembang dan

1
 mengempis sehingga menimbulkan kesulitan bernafas, hal ini menyebabkan
kematian sel pada jaringan.
GDV dapat mengancam jiwa dan menyebabkan kematian. Sehingga
membutuhkan perawatan yang cepat. Dalam keadaan darurat atau parah
biasanya akan dilakukan pembedahan pada daerah abdomen yang bertujuan
untuk mengembalikan posisi gastrium, agar tetap pada posisinya.
Pembedahan yang biasa dilakukan adalah gastrospexy, yaitu membuat insisi
pada dinding lambung bagian luar dengan dinding abdomen di dekatnya
untuk mencegah rotasi gastrium.

1.2 Rumusan Masalah

1. Apa yang dimaksud dengan pembedahan gastropexy?
2. Apa tujuan dari pembedahan gastropexy?
3. Bagaimana teknik pembedahan gastropexy?

1.3 Tujuan Penulisan

1. Untuk mengetahui pengertian dari pembedahan gastropexy.
2. Untuk mengetahui tujuan pembedahan gastropexy.
3. Untuk mengetahui teknik pembedahan gastropexy.

1.4 Manfaat Penulisan

Berdasarkan tujuan penulisan diatas, maka manfaat yang diperoleh
dari penulisan makalah ini adalah sebagai berikut:
1. Manfaat teoritis
Penulis mengharapkan makalah ini dapat memberikan manfaat bagi
pembaca untuk memahami dan mengerti mengenai teknik operasi
Gastropexy pada hewan serta dapat menjadi bahan bacaan untuk
matakuliah Ilmu Bedah Khusus Veteriner.
2. Manfaat praktis
Praktis pembuatan makalah ini dapat memberikan manfaat bagi penulis
yaitu dapat menambah wawasan mengenai operasi Gastropexy pada
hewan.

2
 BAB II

TINJAUAN PUSTAKA

2.1 Definisi Gastropexy

Gastropexy merupakan salah satu tindakan pembedahan elektif (elective

surgery) dimana dilakukan penempelan secara permanen salah satu ujung
bagian perut ke dinding tubuh. Prosedur ini sering dilakukan untuk mencegah
Gastric Dilatation and Volvulus (GDV). GDV merupakan salah satu bentuk
komplikasi dari kembung. Pembedahan biasanya direkomendasikan dibanyak
breed yang besar. Anjing yang memiliki berat lebih dari 99 lbs bisa dikatakan
memiliki kemungkinan 20% kembung dalam masa hidupnya, sehingga
gastropexy merupakan salah satu bentuk rekomendasi untuk dilakukan.

Berikut merupakan beberapa jenis breed anjing yang direkomendasikan

untuk melakkan gastropexy :

- Great Dane
- Golden Retriever
- Labrador Retriever
- St. Bernard
- German Shepherd dan lain-lain

Gastropexy sangat efektif untuk mencegah GDV dan baik dilakukan

bersamaan saat operasi sterilisasi pada hewan. Pembedahan dapat dilakukan
pada umur apa saja dan daerah pemotongan dapat dierkecil secara signifikan
bila menggunakan alat laparoscopic. Pada prakteknya, bagian perut akan
dilekatkan di bagian kanan dari dinding abdomen sehingga tidak terjadi
perpindahan atau terputar. Penggunaan Teknik laparoskopi menunjukan tidak
ada tanda kegagalan. Semua anjing tampak memiliki adhesi yang kuat antara
lapisan seromuscular perut dan otot transversus abdominis (Dujowich et al.,
2010).

3
2.2 Tujuan Gastropexy

Gastropexy adalah operasi elektif yang memiliki fungsi sebagai usaha

preventif dari penyakit Gastric Dilatation and Volvulus ( GDV). Tindakan
preventif ini biasanya dilakukan pada anjing besar. Karena setelah dilakukan
gastropexy, hanya ada kemungkinan 4,3% saja kejadian GDV terulang lagi,
dibandingan dengan 54,5% pada anjing yang tidak melakukan gastropexy (
Glickman et al., 1998). Terdapat dua indikasi dimana sebaiknya dilakukan
gastropexy :

1. Prophylactic gastropexy, jenis gastropexy yang dilakukan sebagai usaha

untuk mencegah GDV. Biasanya dilakukan di anjing mudah yang
memiliki resiko tinggi dan dilakukan saat bersamaan dengan operasi
sterilisasi. Sangat direkomendasikan dialkukan di breed Great Danes.
Karena diestimasikan ada kemungkinan 40% breed Great Danes untuk
terkena GDV pada waktu hidupnya.
2. Gastric dilatation and volvulus, anjing yang terkena GDV diperlukan
operasi emergensi untuk merotasi kembali bagian perut dan setelah itu
dilakukan gastropexy. Setelah dikembalikan dalam posisi normal maka
gastropexy dilakukan dengan melekatkan perut untuk mencegah GDV
terjadi lagi.

Gambar 1. Gastropexy pada Anjing

4
 BAB III

PEMBAHASAN

3.1 Manajemen Pre Operasi

Adapun beberapa hal yang harus diperhatikan sebelum tindakan pembedah

diantaranya ; Persiapan ruang operasi, persiapan alat dan bahan, persiapan
operator, dan persiapan pasien

Ruang operasi dan meja operasi di desinfeksi di desinfeksi menggunakan

desinfektan. Selain itu, perlengkapan alat juga di desinfeksi. Kemudian difumigasi
dengan formalin 10% dan KMnO4 1% dan di biarkan selama 15 menit. Peralatan
bedah dan bahan terkait misalnya seperangkat alat bedah minor, Sterilisasi alat
bedah minor dengan alkohol 70%, desinfektan, bahan premeikasi dan anestesi,
cairan infus, antibiotik, dll. Operator harus menggunakan alat pelindung diri,
untuk tujuan sterilitas prosedur pelaksanaan operasi.

Sebelum tindakan operasi dilaksanakan, hewan terlebih dahulu

dianamnese, pemeriksaan fisik secara umum. Kebanyakan pasien yang akan
menjalani operasi gastropexy harus sehat atau mungkin memiliki penyakit
sistemik yang bersifat ringan. Sehingga dapat mendukung penggunaan anestesi
umum ketika operasi berlangsung. Pasien harus dipuasakan guna untuk
menghindari refluks selama teranestesi.

Premedikasi dan Anestesi

Premedikasi merupakan suatu tindakan pemberian obat sebelum

pemberian anestesi yang dapat menginduksi jalannya anestesi. Premedikasi
dilakukan beberapa saat sebelum anestesi di lakukan. Tujuan premedikasi adalah
untuk mengurangi kecemasan, memperlancar induksi, mengurangi keadaan gawat
anestesi, mengurangi timbulnya hipersalivasi, bradikardia dan muntah selama
anestesi. Anastesi yang dilakukan pada operasi Gastropexy yaitu anestesi umum.
Pada operasi Gastropexy, premedikasi yang digunakan adalah Atropin
Sulfat dengan dosis 0,04 – 0,1 mg/kg BB secara sub kutan (SC). Selanjutnya

5
sebagai Anestesi, digunakan Ketamine yang dikombinasikan dengan Xylazine dan
disuntikkan 10 menit setelah Atropin Sulfat dengan dosis Ketamine 10 – 40mg/kg
BB dan dosis Xylazine 1 – 3 mg/kg BB yang disuntikkan secara Intramuskuler
(IM). Setelah pemberian anestesi, frekuensi nafas dan denyut jantung
dimonitoring setiap 5 – 10 menit sampai pembedahan selesai.
Untuk premedikasi dapat juga digunakan Acepromazine (0.05 mg/kg) dan
Morphine Hydrochloride (0.2 mg/kg) yang diberikan secara sub kutan (SC).
Setelah 30 menit diberikan anestesi umum menggunakan Thiopental (10-15
mg/kg) secara intravena (IV). Setelah pemberian anestesi, frekuensi nafas dan
denyut jantung dimonitoring. Ringer laktat diberikan (11mL / kg / jam IV) selama
operasi. Antibiotik tidak diberikan.

3.2 Prosedur Operasi

Gastropexy dilakukan dengan posisi hewan dorsal recumbency untuk

dilakukan laparotomy ( Belandria, Gerardo A. et al 2009) dan untuk dokter
hewan yang akan melakukan operasi disarankan untuk berdiri di bagian sebelah
kanan pasien untuk menarik dan memposisikan viscera. Sayatan dibuat dari
xiphoid ke preputium pada jantan dan dari xiphoid ke tengah antara umbilucus
pada betina. Jaringan kulit dan fascia kemudian diinsisi, dan rongga peritoneum
dimasukkan melalui sayatan di linea alba. ligamentum falciform diinsisi dan
ditarik ke kanan untuk memberikan visualisasi yang luas dan akses yang baik ke
tulang rusuk terakhir untuk di palpasi. dan untuk memungkinkan visibilitas yang
memadai dari insersi diafragma (Formaggini, 2001).

Laparoskopi gastropexy dilakukan dengan menggunakan tiga portal garis

tengah ventral untuk memanipulasi lambung, membuat sayatan seromuskuler
lambung longitudinal dan menjahit secara intracorporeal ini ke tepi sayatan otot
perut transversal horizontal.

6
 Gambaran teknik operasi gastropexy adalah sebagai berikut:

1. Dinding bagian abdomen diinsisi sekitar 4-5 cm sampai bagian tranversus

abdominis, dan 2-3 cm sampai tulang rusuk terakhir, hati-hati saat melakukan
insisi agar tidak terkena diafragma

1
Gambar 1 : Insisi dinding
abdomen

Sumber : (Rawlings, 2013)

2. Sayatan bagian antral di tengah dengan kelengkungan semakin besar dan

lebih rendah, dengan ujung aboral sekitar 6 cm oral dari pylorus. Sayatannya
panjang sama dengan transversus abdominis (4-5 cm). Hanya lapisan serosal
dan muskularis yang diinsisi, dilakukan hati-hati untuk menghindari penetrasi
lumen

Gambar 2 : membuat sayatan bagian antral

Sumber : (Rawlings, 2013)

7
3. Bagian submukosa harus menonjol dari insisi antral agar gampang
dipisah dari lapisan seromuscular. Aposisi pada batas cranial
dari antral dan dinding abdomen untuk diinsisi.

Gambar 3: insisi bagian submukosa yang menonjol

Sumber : (Rawlings, 2013)

4. Jahitan penguat digunakan untuk mempertahan aposisi selama

penjahitan pada gastropexy dan mengurangi ketegangan pada
penutupan primer setelah operasi. Penguat ini dapat
menggunakan pola jahitan terputus dan pola jahitan menerus.
Posisi dari antrum ke dinding abdominal, dimulai dari bagian
dorsal menuju ke ventral. Untuk lumen tidak diperbolehkan
menggunakan pola jahitan Connell.

8
 4

Gambar 4: penjahitan untuk mempertahan aposisi

Sumber : (Rawlings, 2013)

5. Pada saat satu pola jahitan penguat dimulai, penutupan pertama

dimulai, jarum kemudian dimasukkan dari bagian yang diinsisi,
dan berhati-hati agar tidak terkena mukosa dan diperoleh dari
bagian substansial dari lapisan mukosa dan serosa.

5 1

Gambar 5: Penutupan pertama

Sumber : (Rawlings, 2013)

9
6. Diantara pola jahitan menerus kebagian ventral (medial) komisura,
dimana terikat sebelum dilanjutkan ke bagian caudal. Pentupan
utama pada batas caudal.

Gambar 6: Penutupan pertama pada batas caudal

Sumber : (Rawlings, 2013)

7. Bagian gastropexy diposisikan untuk menampakan bagian batas

caudal

Gambar 7: Bagian gastropexy diposisikan

Sumber : (Rawlings, 2013)

10
8. Jahitan utama menerus dari medial ke lateral,
dimana itu diikat untuk menandai dari simpul awal
untuk penutupan primer. Jahitan diperkuat pada
bagian batas caudal.

8
1
Gambar 8: Jahitan penutupan primer

Sumber : (Rawlings, 2013)

9. Setelah selesai garis jahitan pertama, jahitan penguat diikat

dari medial dan kemudian diteruskan kebagian caudal.

Gambar 9: Jahitan penguat ke arah caudal

Sumber : (Rawlings, 2013)

11
10. Gastropexy selesai (Rawlings, 2013).

10

Gambar 10: Gastropexy selesai

Sumber : (Rawlings, 2013)

12
3.3 Prosedur Pasca Operasi

Pasien harus dikurung selama minimal dua minggu setelah operasi untuk
memungkinkan luka operasi sembuh. Hanya tiga kegiatan yang diizinkan selama
ini:

1. Pasien dapat berada di rumah di bawah kendali (tali) pemilik, hanya di atas
permukaan karpet, tanpa bermain.
2. Pasien dibiarkan dalam kandang atau exercise pen sementara tanpa
pengawasan. Jangan pernah menempatkan pasien di luar untuk lari, di
teras atau bebas di halaman belakang.
3. Pasien berada di bawah pengawasan langsung dari pemilik dengan tali saat
berada di luar untuk berjemur.
Aktivitas yang Tidak Diijinkan:

1. Tidak Ada Aktivitas Bebas (bermain, melompat, berlari atau berjalan kaki yang
berat).

2. Tidak Ada Tangga (1 atau 2 boleh pergi ke luar)

3. Tidak ada runitas lari atau "Doggie Doors"

4. Tidak ada lantai yang licin (ubin, linoleum atau kayu)

5. Pengurungan umum (garasi, teras, kamar mandi, teras, ruang binatu, kamar
tidur atau dapur) diperbolehkan.

Sebagian besar anjing melakukannya dengan sangat baik dengan pembatasan

kurungan. Namun, jika anjing sulit dikendalikan atau memiliki jumlah energi
yang terlalu banyak, penggunaan obat penenang dalam jumlah kecil mungkin
diperlukan untuk membantu selama masa kurungan ini.

13
Petunjuk Operasional Pasca Lainnya

1. Jahitan atau Staples dilepas setelah sepuluh hari..

Menjilat pada sayatan harus dicegah karena dapat menyebabkan mengunyah

jahitan atau staples yang menyebabkan infeksi luka. Mungkin perlu untuk
membalut kaki atau menggunakan kerah Elizabethan untuk mencegah menjilati.

14
 BAB IV
PENUTUP

4.1 Kesimpulan

GDV adalah kondisi di mana perut membalik dan mengembang,

memerangkap udara dan gas di lambung. Gastropeksi adalah pencegahan yang
efektif terhadap kematian dari GDV pada anjing besar. Tanda-tanda GDV
termasuk distensi abdomen, muntah-muntah tanpa muntah, air liur berlebihan, dan
ketidaknyamanan perut. Anjing itu mungkin menjadi lemah dan telentang dan
mengembangkan tandatanda syok. Jenis-jenis Gastropeksi meliputi Belt Loop
Gastropexy, Gastropexy Circumcostal, Insisi Gastropexy, dan Tube Gastrotomy

4.2 Saran

Saran yang dapat diebrikan kepada owner ataupun pembaca, sebaiknya

hewan peliharaan selalu di periksa kesehatannya ke dokter hewan, terutama
kesehatan fisik. Dan memperhatikan nutrisi pakan yang baik dan tepat untuk
diberikan kepada hewan peliharaannya. Dan selalu memperhatikan tingkah laku
yang tidak biasa pada hewan.

15
 Daftar pustaka
Hines, Ron. 2006. Gastric Dilatation Volvulus ( GDV) Bloat and Torsion. All
Creature Care. Australia.

Goldehammer,M.A. 2010. Assessment Of The Incidence Of GDV Following

Splenectomy In Dogs. Journal Of Small Animal Practice. Vol. 51: 23-28.

Anonim. Preventative gastropexy can save a large dog’s life. Toronto. 2017.
http://www.vetstoronto.com/vets-blog/preventative-gastropexy-can-save-a-
large-do. (Diakses pada tanggal 24 Oktober 2017)

Suka veteriner. 2011.Gastric dilation dan volvulus syndrome (GDV) .

http://sukaveteriner.blogspot.com/2011/12/. Diakses pada tanggal 17
oktober 2018.

Belandria dkk.2009. Gastropexy with an automatic stapling instrument for

the treatment of gastric dilatation and volvulus in 20 dogs. Canvet.com

Formaggini. Luca. 2001. Using a Modified Gastropexy Technique to

Prevent

Recurrence of Gastric Dilatation-Volvulus in Dogs. University of Florida

L.T. Glickman, G.C. Lantz, D.B. Schellenberg, & N.W. Glickman .A

prospective study of survival and recurrence following the acute gastric
dilatation-volvulus syndrome in 136 dogs. Journal of the American Animal
Hospital Association, Vol 34, pages 253–259, 1998.

Dujowich, M., Keller, M. E., & Reimer, S. B. 2010. Evaluation of short- and
long-term complications after endoscopically assisted gastropexy in dogs.
Journal of the American Veterinary Medical Association, 236(2), 177–
182.

16
17
Evaluation of short- and long-term complications

SMALL ANIMALS
after endoscopically assisted gastropexy in dogs
Mauricio Dujowich, dvm; Mattew E. Keller, ba; S. Brent Reimer, dvm, dacvs

Objective—To determine short- and long-term complications in clinically normal dogs after
endoscopically assisted gastropexy.
Design—Prospective case series.
Animals—24 dogs.
Procedures—Endoscopically assisted gastropexy was performed on each dog. Dogs were
evaluated laparoscopically at 1 or 6 months after surgery to assess integrity of the gastro-
pexy. Long-term outcome was determined via telephone conversations conducted with
owners ≥ 1 year after surgery.
Results—Mean ± SD gastropexy length was 4.5 ± 0.9 cm, and mean duration of surgery
was 22 ± 5 minutes. One dog had a partially rotated stomach at the time of insufflation,
which was corrected by untwisting the stomach with Babcock forceps. Two dogs vomited
within 4 weeks after surgery, but the vomiting resolved in both dogs. Four dogs had diar-
rhea within 4 weeks after surgery, which resolved without medical intervention. In all dogs,
the gastropexy site was firmly adhered to the abdominal wall at the level of the pyloric
antrum. Long-term follow-up information was available for 23 dogs, none of which had any
episodes of gastric dilatation-volvulus a mean of 1.4 years after gastropexy.
Conclusions and Clinical Relevance—Endoscopically assisted gastropexy can be a sim-
ple, fast, safe, and reliable method for performing prophylactic gastropexy in dogs. At 1
and 6 months after gastropexy, adequate placement and adhesion of the gastropexy site to
the body wall was confirmed. Such a procedure could maximize the benefits of minimally
invasive surgery, such as decreases in morbidity rate and anesthetic time. This technique
appeared to be suitable as an alternative to laparoscopic-assisted gastropexy. (J Am Vet
Med Assoc 2010;236:177–182)

D espite advances in critical care and anesthetic mon-

itoring and an increased awareness by owners of
dogs predisposed to develop GDV, the condition con-
tinues to be associated with relatively high morbidity
and mortality rates. In the past, mortality rates for dogs
with GDV were approximately 50%1–3; however, mor-
tality rates between 15% and 20% have been reported
more recently.4,5 For this reason, many veterinarians
have begun to advocate prophylactic gastropexy for
higher-risk patients.6–13 The lifetime risk of certain
dogs predisposed to develop GDV has been estimated
to be between 4% and 37%.7 These dogs include, but
are not limited to, large- to giant-breed dogs (especially
Great Danes), dogs with a first-degree relative that has
had GDV, excessively anxious dogs, and inappropri-
ately rapid eaters.14–16 On the basis of inquiries about
the number of prophylactic gastropexies performed by
veterinarians in the geographic area surrounding the
veterinary practice of the authors, we suspected that
prophylactic gastropexy was not widely performed by
veterinarians for a number of reasons, including lack of
client and veterinarian education, cost, morbidity, and
From the Department of Veterinary Clinical Sciences, College of Veterinary
Medicine, Iowa State University, Ames, IA 50011. Dr. Dujowich’s present
address is Veterinary Specialty Hospital, 10435 Sorrento Valley Rd, San
Diego, CA 92121. Dr. Reimer’s present address is Iowa Veterinary Spe-
cialties, 6610 Creston Ave, Des Moines, IA 50321.
Address correspondence to Dr. Dujowich (mauricio.dujowich@vshsd.com).
GDV
Abbreviation
Gastric dilatation-volvulus
a perception of the invasiveness of the procedure. Pre-
sumably, similar reasons would contribute to a low fre-
quency of prophylactic gastropexies being performed
throughout the United States.
Minimally invasive procedures continue to be in-
troduced to the veterinary field and are gaining popu-
larity among veterinary surgeons.17–22 Although poten-
tially challenging, these procedures are advantageous in
humans in that they are associated with a decrease in
incision size, decrease in the duration of hospitaliza-
tion, decrease in morbidity, decrease in incisional com-
plications, and improved cosmetic appearance, com-
pared with results for conventional surgery.22–24 Clearly,
these advantages are magnified when performing a pro-
phylactic procedure.
Currently, prophylactic gastropexies can be per-
formed via an open approach or several techniques de-
scribed elsewhere.25–33 Each of these techniques requires
a large incision and is widely considered a major surgical
procedure as a result of the necessary large exposure and
amount of time required to perform the surgery. Many
owners and veterinarians consider such a procedure ex-
cessively invasive for a young healthy dog with an uncer-
tain probability of developing GDV later in life.

JAVMA, Vol 236, No. 2, January 15, 2010 Scientific Reports 177
 More recently, minimally invasive alternatives have
been described and are gaining interest among veteri-
SMALL ANIMALS
narians.8–11 These include laparoscopic-assisted gastro-
pexy, grid-approach gastropexy, and total laparoscopic
gastropexy. The major drawback to these procedures is
the need for expensive instruments for the laparoscop-
ic technique, duration of the procedure, and possible
increase in the risk of damaging other organs by use
of the grid approach.8–10,34,35 In another report36 by our
laboratory group, we described a technique for evaluat-
ing the feasibility of performing endoscopically assisted
gastropexy. Such a procedure may have benefits simi-
lar to those of other minimally invasive procedures de-
scribed for prophylactic gastropexy.
Briefly, endoscopic-assisted gastropexy involves
insufflation of the stomach and concurrent use of en-
doscopy to provide surgeons with adequate visibility
during percutaneous placement of stay sutures into the
region of the pyloric antrum. The stay sutures are then
pulled taut in an effort to place the stomach directly
against the body wall. An incision between the stay su-
tures provides an approach to the pyloric antrum of the
stomach. A gastropexy is then performed. The purpose
of the study reported here was to evaluate the short-
and long-term outcome for dogs in which endoscopi-
cally assisted gastropexy was performed to aid in the
prevention of GDV.
Materials and Methods
Animals—Twenty-four client-owned dogs were se-
lected for use in the study because of an increased risk
for developing GDV, as determined on the basis of signal-
ment or a family history of GDV. Dogs were not excluded
on the basis of body weight, breed, age, or sex. For each
dog, results of a serum biochemical analysis and CBC
were assessed prior to inclusion in the study. Owners
were charged a reduced fee for the endoscopically assisted
gastropexy and were not charged a fee for the follow-up
laparoscopic procedure. At the time of enrollment of their
dogs, clients signed a consent form acknowledging the
potential risks from the gastropexy and anesthesia as well
as potential complications associated with the subsequent
laparoscopic examination 1 or 6 months after the gastro-
pexy. The study was approved by the Iowa State Univer-
sity Institutional Animal Care and Use Committee.
Surgical procedures—Food was withheld from each
dog for 12 hours before anesthesia. Each dog was anes-
thetized in accordance with a protocol approved by the
attending anesthesiologist. Briefly, dogs were premedi-
cated with 1 or a combination of the following: butor-
phanol tartrate, hydromorphone, acepromazine maleate,
or diazepam. Anesthesia was induced by administration
of propofol or thiopental. Anesthesia was then main-
tained by administration of isoflurane in oxygen. Hair on
the abdomen of each dog was clipped, and the abdomen
was routinely prepared for surgery. Each dog was also
placed on a recirculating warm water blanket to reduce
the likelihood of it becoming hypothermic, and routine
monitoring was performed throughout the procedure.
Lactated Ringer’s solution was administered IV at a rate
of 10 mL/kg/h (4.5 mL/lb/h) during the procedure. All
surgeries were performed by one of the authors (SBR).
178 Scientific Reports JAVMA, Vol 236, No. 2, January 15, 2010
Each dog was positioned in left oblique recumbency.
The table was tilted (head upward) 30° from a horizon-
tal plane such that the hind quarters were approximately
30° below the head. A videogastroscopea (insertion tube
length, 103 cm; outer diameter, 8.6 mm) was passed
through the mouth of each dog and advanced to the
stomach. The stomach was then insufflated with room air
until rugal folds were minimally visible and adequate dis-
tention was achieved. In a few dogs, the cervical portion
of the esophagus was compressed by an assistant to help
achieve gastric distention. To locate the anatomic site for
location of the procedure, external compression across
the body wall was performed by use of curved Rochester-
Carmalt hemostatic forceps, with simultaneous viewing
of the pyloric antrum via the endoscope. The stomach
was briefly evaluated for evidence of gross pathological
changes. Number 2 polypropylene sutureb on a cutting
needle (needle length, 76 mm) was passed through the
right lateral aspect of the body wall immediately caudal
to the 13th rib; the needle and suture were viewed endo-
scopically as they entered and exited the stomach at the
level of the pyloric antrum (approx 2 to 3 cm proximal
to the pylorus) before exiting the body wall again. The
resulting stay suture incorporated approximately 2 cm of
tissue. The suture was then pulled taut and temporarily
secured in place with mosquito hemostats. An addition-
al piece of suture was then inserted approximately 4 to
5 cm aborad from the initial suture in the region of the
pyloric antrum.
An incision was made through the skin, subcuta-
neous tissues, and layers of the abdominal musculature
between the 2 stay sutures; dissection of tissues was per-
formed until the stomach was visible. Orientation of the
incision differed but typically was perpendicular to the
13th rib. The abdominal musculature was incised sharp-
ly; the various muscles were not bluntly dissected in a
grid manner. Hemostasis was achieved by application of
manual pressure, use of curved hemostats, and ligation
of larger vessels with 3-0 polydioxanone suture.b Two
Gelpi self-retaining retractors were placed perpendicular
to each other in the incision to allow better visibility. A
longitudinal incision (approx 4 cm in length) was then
made through the serosal and muscular layers of the py-
loric antrum, as described elsewhere.36
For the purposes of the study, an adequate gastro-
pexy was considered to be a minimum of 3 cm in length.
Length of each gastropexy was measured to the nearest
millimeter by use of the scale on a scalpel handle. The
seromuscular layer was sutured to the transversus ab-
dominis muscle by use of 2 separate continuous patterns
with 0 polypropylene sutureb (Figure 1). Suture bites
through the seromuscular layer were initiated at least
1 cm from the cut edge. The external abdominal oblique
muscle was then approximated with 2-0 polydioxanone
sutureb in a simple continuous pattern. Subcutaneous
tissues were closed in a routine manner, and a simple
continuous intradermal pattern with intermittent sutur-
ing to the underlying tissues was performed by use of 3-0
poliglecaprone 25.b Skin sutures were not inserted. Stay
sutures were subsequently removed while the stomach
was endoscopically evaluated and decompressed.
All dogs received hydromorphone (0.1 mg/kg
[0.045 mg/lb], IV) immediately after completion of the

Figure 1—Photograph of the abdomen of a representative dog
during endoscopically assisted gastropexy. The head of the dog
is to the left. Stay sutures (white arrows) have been placed by
use of an endoscope and are used to indicate the area for the
abdominal incision. Notice the seromuscular layer that has been
sutured to the transversus abdominis muscle (black arrow) and
the stomach mucosa, which appears yellow because of illumina-
tion from the endoscope (dashed black arrow).
procedure and were subsequently administered trama-
dol (2 to 3 mg/kg [0.9 to 1.4 mg/lb], PO, q 8 h for 3 to
5 days, as necessary to alleviate pain). Dogs were hos-
pitalized overnight after surgery to enable observation;
dogs were discharged to owners the following day.
Postoperative laparoscopic evaluation—At the
time of enrollment, the first 10 dogs were assigned to
be laparoscopically evaluated 6 months after the endo-
scopically assisted gastropexy was performed, whereas
the remaining dogs enrolled in the study were to be lapa-
roscopically evaluated 1 month after the endoscopically
assisted gastropexy procedure. Food was withheld from
each dog for 12 hours before anesthesia. Each dog was
anesthetized in accordance with a protocol approved
by the attending anesthesiologist and maintained with
isoflurane in oxygen. Hair on the abdomen was clipped,
and the abdomen was routinely prepared for surgery.
Each dog was also placed on a recirculating warm water
blanket to reduce the risk of becoming hypothermic,
and routine monitoring was performed throughout the
procedure. Lactated Ringer’s solution was administered
IV at a rate of 10 mL/kg/h during the procedure.
Briefly, each dog was positioned in dorsal recum-
bency and a Veress needle was introduced approxi-
mately 1 to 2 cm caudal to the xiphoid. The abdomen
was insufflated with carbon dioxide to a pressure of
approximately 14 cm H2O. After adequate insufflation
was achieved, a 5-mm trocar-cannula was introduced
on the right side of the abdomen approximately 2 cm
cranial and lateral to the umbilicus. A 5-mm, 30° lap-
aroscopec was introduced into the abdomen, and the
abdominal cavity was briefly explored. The gastropexy
site was laparoscopically evaluated to assess adequate
placement and healing. Adjacent abdominal organs
were assessed for inadvertent entrapment at the gastro-
pexy site. A 5-mm port was then established on the left
side of the abdomen approximately 2 cm cranial and
lateral to the umbilicus. Laparoscopic Babcock forceps
were introduced into the abdominal cavity and used to
JAVMA, Vol 236, No. 2, January 15, 2010 Scientific Reports 179
place firm traction on the adhesions that had formed
between the abdominal wall and pyloric antrum. A
SMALL ANIMALS
5-mm laparoscopic biopsy instrument was then used to
obtain biopsy specimens from the interface between the
body wall and stomach. Biopsy specimens were submit-
ted for histologic examination.
Long-term postoperative evaluation—All owners
were contacted via telephone at least 1 year after the
gastropexy and asked to participate in a brief survey.
Questions included specific details regarding subse-
quent episodes of GDV, any gastrointestinal signs after
the surgery (eg, vomiting, diarrhea, or anorexia), cli-
ent perception of signs of pain exhibited by the dogs,
and client satisfaction associated with the cosmetic re-
sult. Overall scores for client satisfaction and pain were
rated on a scale of 1 to 10, with a score of 10 being the
most satisfied or the most pain, respectively. Owners
were asked to recall the amount of pain and any poten-
tial complications, despite the prolonged interval since
the prophylactic procedure was performed.
Statistical analysis—Mean, median, range, and SD
values for duration of surgery, length of the gastropexy,
and body weight were calculated. Additionally, mean,
median, range, and SD values were calculated for the
client survey of pain perception and client satisfaction.
Results
Animals—Prophylactic endoscopically assisted
gastropexy was performed on 24 dogs. Follow-up
monitoring was performed for 0.3 to 1.8 years (mean,
1.4 years; median, 1.5 years). Although all breeds were
considered susceptible to developing GDV, breeds
represented in the study included 10 Great Danes, 5
large mixed-breed dogs, 2 Boxers, 1 Irish Wolfhound,
1 French Bulldog, 1 Standard Poodle, 1 Mastiff, 1 Do-
berman Pinscher, 1 Bernese Mountain Dog, and 1 Gi-
ant Schnauzer. There were 6 sexually intact females, 3
spayed females, 4 sexually intact males, and 11 neu-
tered males. Dogs ranged from 0.3 to 8.3 years of age
(mean ± SD, 2.33 ± 1.9 years; median, 2.0 years) at the
time of surgery. Mean body weight ranged from 12.5 to
79.1 kg (27.5 to 174.0 lb), with a mean of 41.5 ± 17.3 kg
(91.3 ± 38.1 lb) and a median of 43.2 kg (95.0 lb). For
all dogs, results of a serum biochemical analysis and CBC
were within reference limits.
Surgical procedure—Mean ± SD duration of sur-
gery for the 24 dogs ranged from 15 to 35 minutes
(mean ± SD, 22 ± 5 minutes; median, 22 minutes).
There were no major surgical or anesthetic complica-
tions encountered during the surgery. The approximate
amount of time for introduction of the gastroscope into
the stomach and achievement of adequate insufflation
was 1 minute. Although intragastric pressure was not
measured, there were no substantial changes in values
for the monitored variables at the time of stomach in-
sufflation. Gastropexy length ranged from 3.0 to 7.0 cm
(mean, 4.5 ± 0.9 cm; median, 4.5 cm).
One dog had a partial rotation of the stomach on
insufflation. This was detected by identifying the pylorus
to the left of midline via percutaneous palpation of the
pyloric antrum while viewing the stomach endoscopi-
 cally. Stay sutures in this dog were placed at the proposed
incision site, which corresponded to the body of the
SMALL ANIMALS
fundus as a result of the partial rotation. The abdomen
was incised between the stay sutures. Once the stomach
was visible, Babcock forceps were used to untwist the
stomach until it was properly positioned for gastropexy.
Proper positioning was confirmed endoscopically.
Postoperative laparoscopic evaluation—Lapa-
roscopic examination was performed on 10 dogs at 1
month and 9 dogs at 6 months after the endoscopically
assisted gastropexy. Five dogs were not laparoscopically
evaluated because of owner noncompliance. All 19 dogs
had a firm gastropexy at the level of the pyloric antrum.
All dogs subjectively had adequate adhesion formation
between the body wall and pyloric antrum, as deter-
mined on the basis of results when we attempted to pull
the pyloric antrum away from the body wall (Figure 2).
Results of histologic examination of biopsy specimens
obtained laparoscopically from the gastropexy site
were available for 9 dogs examined at 1 month and 9
dogs examined at 6 months after gastropexy. All biopsy
specimens had mature granulation tissue, fibrous con-
nective tissue, a tunica muscularis, or a combination of
these 3 findings.
Long-term postoperative evaluation—The own-
ers reported no complications associated with healing
of the incision after the endoscopically assisted gastro-
pexy. All dogs resumed typical activities within 1 week
after surgery. Of the 24 dogs, follow-up information
was available for 23. None of the dogs with follow-up
monitoring had an episode of GDV after the gastro-
pexy (range, 0.4 to 1.8 years; mean, 1.4 years; median,
1.5 years).
Two dogs vomited within 4 weeks after surgery; how-
ever, vomiting resolved in both dogs after administration
of famotidine (0.5 mg/kg [0.23 mg/lb], PO, q 12 h for 7
days). Four dogs had diarrhea within 4 weeks after sur-
gery; diarrhea in all dogs resolved without medical in-
tervention. On a pain scale of 1 to 10 (10 indicated the
most pain), owner-assigned pain score for the dogs after
surgery ranged from 1 to 10 (mean ± SD, 4.2 ± 2.9; me-
Figure 2—Laparoscopic view of the abdomen of a representative
dog 1 month after endoscopically assisted gastropexy. Babcock
forceps are used to place traction on the stomach, which reveals
that a firm adhesion has developed between the site of the gas-
tropexy (just caudal to the 13th rib) and the abdominal wall.
180 Scientific Reports JAVMA, Vol 236, No. 2, January 15, 2010
dian, 4). Two owners believed the pain score was 10 im-
mediately after discharge from our veterinary hospital.
The 2 owners who believed that their dogs had exces-
sive pain were asked to describe the signs of pain. One
owner mentioned that his dog had always been sensitive
to painful conditions and thus was not surprised that
the dog whined after returning home. The other owner
could not accurately recall the exact behavior of the dog
to indicate pain, but he did remember that the dog had
signs of excessive pain.
Twenty-two of 23 owners were satisfied with the
cosmetic outcome of the surgery. On a scale of 1 to 10
(10 indicated the most satisfaction), owner satisfaction
for the outcome of the procedure ranged from 7 to 10
(mean, 9.8; median, 10).
Discussion
The short- and long-term outcome for endoscopi-
cally assisted gastropexy in client-owned dogs was
evaluated in the study reported here. In another study,7
investigators reported that prophylactic gastropexy de-
creased the mortality rate associated with GDV in Great
Danes, Irish Setters, Rottweilers, Standard Poodles, and
Weimaraners. In the short-term period after surgery to
correct GDV, mortality rates among dogs can reach 16%
to 33%.3,5,37,38 Issues associated with performing pro-
phylactic gastropexy include invasiveness of the pro-
cedure, lifetime risk of an episode of GDV, and actual
necessity of prophylactic surgery, and many owners
are unaware of the procedure.7–10,37,39,40 The procedure
evaluated in our study was similar to laparoscopically
assisted gastropexy.8–10 The key difference was that the
procedure performed in our study requires only 1 inci-
sion, which corresponds to the site of the gastropexy.
Thus, our procedure was essentially the same as an in-
cisional gastropexy.
Other investigators have evaluated the integrity of
the adhesion between the stomach and body wall in-
terface. The breaking strength of adhesions resulting
from circumcostal, belt-loop, incisional gastropexy, and
laparoscopically assisted gastropexy ranges from 60 to
approximately 110 N, depending on the type of pro-
cedure and the interval between when the surgery is
performed and the adhesion strength is tested.10,13,27,35,41
We elected to not evaluate the strength of the adhe-
sions because we believed it would not add substantial
insights to the technique described. The ultimate load
necessary to cause failure at the adhesion site of a lapa-
roscopically assisted gastropexy has been described in
detail.10 Given the similarities between the procedures
in that study and the study reported here, we assumed
a similar mean ± SD failure load of 106.5 ± 45.6 N.
Regardless, the strength of an adhesion required to pre-
vent GDV is not known, and breaking strength has not
been correlated with clinical efficacy (ie, a reduction in
the incidence of GDV).10
In our study, we did not detect gross breakdown
of adhesions during the laparoscopic evaluation 1 or 6
months after the surgery. At both of these time points,
laparoscopic examination of the gastropexy site re-
vealed no signs of failure. All dogs appeared to have
a strong adhesion between the seromuscular layer of
the stomach and the transversus abdominis muscle. We
were able to confirm correct anatomic positioning of
the gastropexy in all dogs on which a laparoscopic ex-
amination was performed. Subjectively, there were no
obvious differences in the appearance of the gastropexy
at 1 and 6 months. Histologically, there were no find-
ings indicative of failure or complications in adhesion
formation between the seromuscular layer of the stom-
ach and the transversus abdominis muscle.
Complications associated with traditional gastro-
pexy procedures include rib fracture, dehiscence of
the incision, sepsis, pneumothorax, and recurrence of
gastric dilatation with or without volvulus.13,26,28,30,40,42,43
Less invasive techniques have been described8–10,13,34
that can be used to decrease the morbidity associated
with gastropexy. On the basis of the results reported
here, there were no major surgical complications en-
countered, no issues with healing of the incision or gas-
tropexy site, and no failures identified at the time of
postoperative laparoscopic examination. One dog did
have partial rotation of the stomach at the time of sur-
gery and required detorsion of the stomach for proper
positioning of the gastropexy. This emphasizes the im-
portance of having a surgeon who is comfortable with
endoscopy and anatomy perform the procedure to avoid
inadvertent placement of the gastropexy in an inappro-
priate position. Furthermore, certain complications,
such as perforation of a loop of bowel or major organ at
the time of percutaneous needle advancement into the
stomach, can be envisioned. Needle breakage inside the
abdomen is a potential complication, although the au-
thors have not had this happen with the current selec-
tion of needles. On the basis of the limited number of
dogs in this study, we did not encounter this complica-
tion, and we hope that adequate insufflation will make
this complication an extremely rare event.
Regardless of potential complications, the tech-
nique used here may have an advantage over other
less invasive techniques in that the instrumentation
required may be more widely available because veteri-
narians may already be using the equipment for other
procedures.36 Another notable advantage is that the du-
ration of surgery may be substantially less than for oth-
er prophylactic procedures, which have been reported
to reach approximately 70 minutes of surgical time.35
It is important to mention that practice and increased
surgical efficiency can make it possible to perform all
prophylactic procedures in similar surgical times.
After gastropexy, the dogs subjectively appeared to
be comfortable and did not have signs of excessive pain
while in our veterinary hospital. However, owner assess-
ment of pain indicated that dogs may have signs of pain
after discharge. We assumed that the pain associated
with the procedure would be minimal and that trama-
dol would be sufficient to control this pain. We provided
analgesic rescue if dogs were uncomfortable, but subjec-
tively, we did not detect excessive pain while the dogs
were hospitalized. On the basis of the owners’ responses
to the questionnaire, 2 dogs were classified as having
extreme pain. However, these owners did not make the
authors aware that their dogs had signs of extreme pain;
therefore, no rescue analgesia was provided.
A shortcoming of the study is the retrospective
nature of the questionnaire, which required owners to
JAVMA, Vol 236, No. 2, January 15, 2010 Scientific Reports 181
recall the amount of pain perceived by their dogs. This
SMALL ANIMALS
may have been overestimated or underestimated by the
owners because of the time elapsed since the gastro-
pexy. Although other minimally invasive procedures
have been compared with traditional open procedures
in regard to pain,44,45 the authors are not aware of any
specific studies on pain associated with a gastropexy
technique. It would be interesting to perform a study
to compare signs of pain associated with a variety of
gastropexy techniques. Because this procedure is mini-
mally invasive, we assume that pain associated with the
procedure would be minimal, compared with that for
other techniques.
Only 1 of 24 dogs was lost to follow-up monitor-
ing. All gastropexy procedures were performed in dogs
predisposed to episodes of GDV as a result of their
breed, behavior, or genetics. Postsurgical monitoring
was conducted for a mean of 1.4 years, and there were
no episodes of GDV in the 23 dogs during that time.
Other potential limitations of this study include the
lack of a longer period (ie, lifetime of each dog) of fol-
low-up monitoring, the small sample size, and lack of
proof that the gastropexy will not fail sometime in the
future.
On the basis of the results for the study reported
here, we believe that when performed by a trained and
experienced surgeon, an endoscopically assisted gas-
tropexy is a safe, fast, reliable, and minimally invasive
alternative to other currently available prophylactic
procedures. Endoscopically assisted surgery in humans
potentially maximizes the benefits associated with min-
imally invasive surgery, including a reduction in size
of the incision, a decrease in postoperative pain and
analgesic drug requirements, and a more rapid restora-
tion of physiologic function of the intestinal tract.46,47
Subsequent to the study, the authors have performed
prophylactic endoscopically assisted gastropexy on a
regular basis and have taught the procedure to other
veterinary surgeons. We perceive that becoming profi-
cient in the technique is most difficult for veterinary
surgeons who have no experience with endoscopy, and
we believe that most veterinary surgeons will be com-
fortable with the procedure after performing 4 or 5 sur-
geries. In our limited experience, we have found that
the surgery is simple to perform in most dogs but we
have infrequently encountered a dog in which it was
difficult to achieve the appropriate position or to access
the stomach caudal to the 13th rib, which contributes
to the duration of the procedure as a result of the need
to reposition the dog.
a. GIF-160 gastrointestinal videoscope, Olympus, Tuttlinger, Germany.
b. Ethicon, Somerville, NJ.
c. Stryker Endoscopy, San Jose, Calif.
References
1. Betts CW, Wingfield WC, Green RW. A retrospective study of gastric
dilatation torsion in the dog. J Small Anim Pract 1974;15:727–734.
2. Lance CC, Bottoms CD, Carlton WW. The effect of 360° gastric
volvulus on the blood supply of the now distended normal dog
stomach. Vet Surg 1984;13:189–196.
3. Brockman DJ, Washabau RJ, Drobatz KJ. Canine gastric dilata-
tion/volvulus syndrome in a veterinary critical care unit: 295 cases
(1986–1992). J Am Vet Med Assoc 1995;207:460–464.
 4. Adamik KN, Burgener IA, Kovacevic A, et al. Myoglobin as a
prognostic indicator for outcome in dogs with gastric dilatation-
SMALL ANIMALS
volvulus. J Vet Emerg Crit Care 2009;19:247–253.
5. Beck JJ, Staatz AJ, Pelsue DH, et al. Risk factors associated
with short-term outcome and development of perioperative
complications in dogs undergoing surgery because of gastric
dilatation-volvulus: 166 cases (1992–2003). J Am Vet Med Assoc
2006;229:1934–1939.
6. Ellison GW. Gastric dilatation volvulus: surgical prevention.
Vet Clin North Am Small Anim Pract 1993;23:513–530.
7. Ward MP, Patronek GJ, Glickman LT. Benefits of prophylactic
gastropexy for dogs at risk of gastric dilatation volvulus. Prev Vet
Med 2003;60:319–329.
8. Rawlings CA. Laparoscopic-assisted gastropexy. J Am Anim Hosp
Assoc 2002;38:15–19.
9. Rawlings CA, Mahaffey MB, Bement S, et al. Prospective evalu-
ation of laparoscopic-assisted gastropexy in dogs susceptible to
gastric dilatation. J Am Vet Med Assoc 2002;221:1576–1581.
10. Rawlings CA, Foutz TL, Mahaffey MB, et al. A rapid and
strong laparoscopic-assisted gastropexy in dogs. Am J Vet Res
2001;62:871–875.
11. Mayhew PD, Brown DC. Prospective evaluation of two intra-
corporeally sutured prophylactic laparoscopic gastropexy tech-
niques compared with laparoscopic-assisted gastropexy in dogs.
Vet Surg 2009;28:738–746.
12. Broome CJ, Walsh VP. Gastric dilatation-volvulus in dogs. N Z Vet J
2003;51:275–283.
13. Hardie RJ, Flanders JA, Schmidt P, et al. Biomechanical and his-
tological evaluation of a laparoscopic stapled gastropexy tech-
nique in dogs. Vet Surg 1996;25:127–133.
14. Burrows CF, Ignaszewski LA. Canine gastric dilatation-volvu-
lus. J Small Anim Pract 1990;31:495–501.
15. Glickman LT, Glickman NW, Pérez CM, et al. Analysis of risk
factors for gastric dilatation and dilatation-volvulus in dogs.
J Am Vet Med Assoc 1994;204:1465–1471.
16. Glickman LT, Glickman NW, Schellenberg DB, et al. Multiple
risk factors for the gastric dilatation-volvulus syndrome in dogs:
a practitioner/owner case-control study. J Am Anim Hosp Assoc
1997;33:197–204.
17. Ertelt J, Fehr M. Cranial cruciate ligament repair in dogs with
and without meniscal lesions treated by different minimally in-
vasive methods. Vet Comp Orthop Traumatol 2009;22:21–26.
18. Mayhew PD, Mehler SJ, Radhakrishnan A. Laparoscopic cho-
lecystectomy for management of uncomplicated gall bladder
mucocele in six dogs. Vet Surg 2008;37:625–630.
19. Tonks CA, Tomlinson JL, Cook JL. Evaluation of closed reduc-
tion and screw fixation in lag fashion of sacroiliac fracture-luxa-
tions. Vet Surg 2008;37:603–607.
20. Jimenez Pelaez M, Bouvy BM, Dupre GP. Laparoscopic adrenal-
ectomy for treatment of unilateral adrenocortical carcinomas:
technique, complications, and results in seven dogs. Vet Surg
2008;37:444–453.
21. Gower S, Mayhew PD. Canine laparoscopic and laparoscopic-
assisted ovariohysterectomy and ovariectomy. Compend Contin
Educ Pract Vet 2008;30:430–440.
22. Vitale GC, Davis BR, Tran TC. The advancing art and science of
endoscopy. Am J Surg 2005;190:228–233.
23. Schauer P, Chand B, Brethauer S. New applications for endosco-
py: the emerging field of endoluminal and transgastric bariatric
surgery. Surg Endosc 2007;21:347–356.
24. Kalloo AN, Singh VK, Jagannath SB, et al. Flexible transgastric
peritoneoscopy: a novel approach to diagnostic and therapeu-
tic interventions in the peritoneal cavity. Gastrointest Endosc
2004;60:114–117.
25. MacCoy DM, Sykes GP, Hoeffer RE, et al. A gastropexy tech-
nique for permanent fixation of the pyloric antrum. J Am Anim
Hosp Assoc 1982;18:763–768.
26. Johnson RG, Barrus J, Greene RW. Gastric dilatation-volvulus:
182 Scientific Reports JAVMA, Vol 236, No. 2, January 15, 2010
recurrence rate following tube gastrostomy. J Am Anim Hosp As-
soc 1984;20:33–37.
27. Fox SM, Ellison GW, Miller GJ, et al. Observations on the me-
chanical failure of three gastropexy techniques. J Am Anim Hosp
Assoc 1985;21:729–734.
28. Woolfson JM, Kostolich M. Circumcostal gastropexy: clinical
use of the technique in 34 dogs with gastric dilatation-volvulus.
J Am Anim Hosp Assoc 1986;22:825–830.
29. Leib MS, Konde LJ, Wingfield WE, et al. Circumcostal gas-
tropexy for preventing recurrence of gastric dilatation-volvu-
lus in the dog: an evaluation of 30 cases. J Am Vet Med Assoc
1985;187:245–248.
30. Whitney WO, Scavelli TD, Matthiesen DT, et al. Belt-loop gas-
tropexy: technique and surgical results in 20 dogs. J Am Anim
Hosp Assoc 1989;25:75–83.
31. Meyer-Lindenberg A, Harder A, Fehr M, et al. Treatment of
gastric dilatation-volvulus and a rapid method for prevention
of relapse in dogs: 134 cases (1988–1991). J Am Vet Med Assoc
1993;203:1303–1307.
32. Schulman AJ, Lusk R, Lippincott CL, et al. Muscular flap gastropexy:
a new surgical technique to prevent recurrences of gastric dilatation-
volvulus syndrome. J Am Anim Hosp Assoc 1986;22:339–346.
33. Fox SM, McCoy CP, Cooper RC, et al. Circumcostal gastropexy
versus tube gastrostomy: histological comparison of gastropexy
adhesions. J Am Anim Hosp Assoc 1988;24:273–279.
34. Steelman-Szymeczek SM, Stebbins ME, Hardie EM. Clinical
evaluation of a right-sided prophylactic gastropexy via a grid
approach. J Am Anim Hosp Assoc 2003;39:397–402.
35. Wilson ER, Henderson RA, Montgomery RD, et al. A compari-
son of laparoscopic and belt-loop gastropexy in dogs. Vet Surg
1996;25:221–227.
36. Dujowich M, Reimer SB. Evaluation of an endoscopically assisted
gastropexy technique in dogs. Am J Vet Res 2008;69:537–541.
37. Glickman LT, Lantz GC, Schellenberg DB, et al. A prospective
study of survival and recurrence following the acute gastric dila-
tation-volvulus syndrome in 136 dogs. J Am Anim Hosp Assoc
1998;34:253–259.
38. Brourman JD, Schertel ER, Allen DA, et al. Factors associated
with perioperative mortality in dogs with surgically managed
gastric dilatation-volvulus: 137 cases (1988–1993). J Am Vet
Med Assoc 1996;208:1855–1858.
39. Glickman LT, Glickman NW, Schellenberg DB, et al. Non-di-
etary risk factors for gastric dilatation-volvulus in large and gi-
ant breed dogs. J Am Vet Med Assoc 2000;217:1492–1499.
40. Whitney WO. Complications associated with the medical and
surgical management of gastric dilatation-volvulus in the dog.
Probl Vet Med 1989;1:268–280.
41. Waschak MJ, Payne JT, Pope ER, et al. Evaluation of percutane-
ous gastrostomy as a technique for a permanent gastropexy. Vet
Surg 1997;26:235–241.
42. Flanders JA, Harvey HJ. Results of tube gastrostomy as treatment for
gastric volvulus in the dog. J Am Vet Med Assoc 1984;185:74–77.
43. Eggertsdottir AV, Stigen O, Lonaas L, et al. Comparison of the
recurrence rate of gastric dilatation with or without volvulus
in dogs after circumcostal gastropexy versus gastrocolopexy. Vet
Surg 2001;30:546–551.
44. Davidson EB, Moll HD, Payton ME. Comparison of laparoscop-
ic ovariohysterectomy and ovariohysterectomy in dogs. Vet Surg
2004;33:62–69.
45. Devitt CM, Cox RE, Hailey JJ. Duration, complications, stress,
and pain of open ovariohysterectomy versus a simple method of
laparoscopic-assisted ovariohysterectomy in dogs. J Am Vet Med
Assoc 2005;227:921–927.
46. Robinson TN, Stiegmann GV. Minimally invasive surgery. En-
doscopy 2004;36:48–51.
47. Beger HG, Schwarz A, Bergmann U. Progress in gastrointestinal
tract surgery: the impact of gastrointestinal endoscopy. Surg En-
dosc 2003;17:342–350.
Veterinary World, 2010, Vol.3(12):554-557 REVIEW

Gastric Dilation and Volvulus Syndrome in Dog

Ami S. Bhatia, P.H. Tank, A. S. Karle, H.S. Vedpathak and M.A. Dhami

Department of Veterinary Surgery and Radiology

College of Veterinary Science and Animal Husbandry
Anand Agricultural University, Anand-388001, Gujarat, India

Abstract
Gastric dilatation and volvulus syndrome (GDV) in dogs is an abnormal accumulation of gastric
gas (dilatation), which may be complicated by rotation of the stomach (volvulus) about its
mesentric axis. A number of factors, both environmental and host have been implicated in GDV.
This syndrome has a variety of effects on the cardiovascular, respiratory, gastrointestinal,
metabolic, haemolymphatic-immune, renal and central nervous systems. Clinical signs include
distended, painful, tympanic abdomen, retching, unproductive vomiting, hypersalivation,
respiratory distress accompanied by varying degrees of shock. Treatment of GDV includes
medical and fluid therapy at shock dosages to initially stabilize the patient followed by gastric
decompression. Surgical procedure comprises of gastric derotation followed by partial
gastrectomy or spleenectomy depending upon gastric or spleenic viability and lastly,
permanent right sided gastropexy. Post surgical considerations include frequent small meals
instead of one large meal, avoiding vigorous activity immediately after meals and not allowing
animal to gorge on water after meals or activities.
Keywords : Gastric Dilatation,dogs,Volvulus.

Introduction factors unique to these cases.Treatment may range

from conservative to aggressive on the basis of these
Gastric dilatation and volvulus is an abnormal
details.
accumulation of gastric gas (dilatation),which may be
complicated by rotation of the stomach (volvulus) Risk Factors
about its mesenteric axis. A series of per-acute patho- A number of factors, both environmental and
physiological changes occur that are responsible for
host have been implicated in gastric dilatation and
the high mortality rate associated with this condition
volvulus. These include breed, age, sex, chest
(Williams,1991). Acute gastric dilatation and gastric
confirmation, diet, stress and exercise patterns
dilatation with volvulus are differentiated from food
(Glickman et al.2000). In summary these multiple
engorgement (food bloat) which is charachterised by a
studies suggest the following:
known or presumed consumption of food resulting in
an overdistended, food filled stomach in a normal 1. Large and giant breeds viz. Great Dane, German
position. Chronic gastric volvulus is a subcategory of Shephard, Standard Poodle,Weimeraner, Saint
gastric dilatation with volvulus. Signs are subtle and Bernard, Gordon / Irish Setter, Large Mixed
varied; diagnosis may not be made until a routine Breed, Smaller Breeds: Bassett Hound,
diagnostic evaluation is carried out for intermittent Dachschund
bouts of weight loss, borborygmus, flatulence, 2. Dogs with close relative who’ve had GDV
eructation or vomiting and the volvulus happens to be 3. Large thoracic depth to width ratio
present during that evaluation (Frendin et al.,1988). 4. Underweight for breed
Acute gastric dilation and gastric dilatation with 5. Increasing age
volvulus have been recognised to affect the dog 6. Previous spleenomegaly or splenectomy
population for many decades, yet pathogenesis 7. Aerophagia/gulping food
remains unclear. Which condition develops first, 8. Eating from a raised bowl
dilatation or volvulus, has been debated extensively, 9. Stress
consensus suggests that dilatation precedes volvulus 10. Feeding once a day and small food particle
(Betts et al.,1974). The decision for care is based on the size (<30mm diameter) (Williams et al.,1999).
www.veterinaryworld.org Veterinary World, Vol.3 No.12 December 2010 554
 Gastric Dilation and Volvulus Syndrome in Dog

Patho-Physiology restlessness, gums are pale or cyanotic, dog appears

Gaseous/fluid distension of the stomach alters “shaky” when standing, or cannot stand, abdomen very
the normal position of the pylorus and lower large, tachycardia (+100 bpm),weak pulse.
esophageal sphincter, limiting eructation and abroad Radiography
elimination of entrapped materials. Distension and Abdominal radiography is not performed until
displacement of the stomach have a variety of effects after medical stabilization. The right lateral position is
on the cardiovascular, respiratory, gastrointestinal, most revealing(Hathcock ,1984). Gastric dilation(with
metabolic, haemo-lymphatic, immune, renal and or without volvulus) is confirmed if a gas distended
central nervous system. gastric shadow is present with various degrees of gas
A. Direct cardiovascular effect : filled small or large intestine. Volvulus is suspected if a
A rapidly distending stomach and increased tissue density seperates the gas filled gastric shadow
general intra-abdominal pressure results in into two chambers or the pylorus is dorsocranial to the
compression of intra-abdominal veins, caudal fundus in the right lateral view.
venacava, portal vein and splanchnic vasculature.
(Wingfield et al.,1975).This venous occlusion causes Gastric Decompression
both a forward reduction in vascular volume and a 1. Orogastric intubation - “Stomach Tube”
backward increase in venous pressure leading to poor 2. Needle trocarization
venous return and splanchnic pooling with resulting Orogastric intubation: A lubricated stomach tube is
reduction in cardiac output and systemic blood passed to the stomach to relieve gastric
pressure. compression.Be sure to advance the tube carefully at
B.Direct Respiratory effects: the gastroesophageal junction. If resistance is found,
As the stomach distends, it pushes cranially on rotate tube and then advance. Passage of the stomach
the diaphragm preventing normal excursions; tidal tube into stomach lumen does not mean that there is no
volume is reduced in compensation, respiratory rate gastric rotation.
and effor ts are increased. Ultimately,these Needle Trocarization : An 18 gauge needle is used to
compensatory efforts cease to meet demands for puncture the distended stomach. The stomach wall is
oxygenation and carbon dioxide elimination; pCO2 against the body wall so other viscera is displaced,
rises first(stimulating more effort) and pO2 falls when hence low risk of injury to other tissues.
the respiratory system has exceeded its abilities. The
elevated pco2 creates a respiratory acidosis. Treatment of Shock
C.Direct Gastrointestinal effects: Fluid Type Rate
Increased intraluminal gastric pressure reduces Crystalloids Lactated Ringer’s solution Initially 0ml/kg/hr.monitor
response and reduce as
the myoelectrical activity of the stomach.(Hall et needed.
al.,1993) further exacerbating the accumulation of gas Colloids Haemaccel
and fluid and preventing normal recovery. Gastric (3.5% polygeline) 20ml/kg q24h
necrosis due to torsion, occlusion and avulsion of short Combinations 7% saline with colloid 5ml/kg over 15 min
Blood Haemoglobin
gastric arteries supplying the greater curvature and substitute glutamer 200
fundus of the stomach. Spleenic infarcts and necrosis (oxyglobin,biopure) 10ml/kg/hr
seen due to compromise of the spleenic vasculature Total dose should not
during volvulus. exceed 30ml/kg

D.Metabolic effects: Anaesthesia

Acid-base and potassium abnormalities, glucose
abnormalities, reperfusion injuries, disseminated
intravascular coagulopathy, endotoxemia, renal effects
have been seen.
Diagnosis
Signalment : Acute gastric dilation or gastric dilatation
with volvulus is usually diagnosed by signalment,
history and physical findings.
Presumptive diagnosis is based on:
1. Clinical findings
2. Radiography
Clinical Signs: Pacing, restlessness, salivation,
panting, ineffective vomiting attempts, increased
• Neuroleptoanalgesics or narcotics preferred for
induction.
• Phenothiazine derivatives,alpha agonists contra
indicated since they further lower BP in
compromised patients. (Thurman et al.,1996).
• Maintained with gas anaesthetics viz. isoflurane
or sevoflurane.
• Nitrous oxide is contraindicated as it causes
further gastric distension.
Surgical Anatomy and Rotation
1. Clockwise rotation of stomach is most common.
2. Most rotations are between 180 and 270
degrees.

www.veterinaryworld.org Veterinary World, Vol.3 No.12 December 2010 555

 Gastric Dilation and Volvulus Syndrome in Dog
3. Occasionally, counterclockwise rotation of 90
degrees is seen.
4. Stomach is rotated about the distal esophagus
and tilted cranially.
Determination of Stomach Ability
After repositioning the stomach, gastric viability
is assessed and devitalized areas are excised by
partial gastrectomy.Fluorescein has been used to
predict gastric wall necrosis but does not provide better
predictability than visual and tactile means. (Wheatson
et al.,1986).
Serosal Color - gray / green,thickness of stomach
wall – thin, fragile and no vascular patency indicates
devitalized tissue.
Gastropexy: The goal of gastropexy is to produce a
permanent adhesion between the pyloric antrum and
the right lateral body wall to prevent rotation of the
stomach. Recurrence rates can be as high as 80% if
gastropexy is not carried out.A number of gastropexy
techniques have been identified these are:
Beltloop Gastropexy: This technique uses a flap of
gastric wall passed through a tunnelin the right lateral
abdominal wallto create a permanent gastropexy.
Whitney et al.,1989 reported significant,short,fibrous
adhesions between the pyloric antrum and the right
body wall.
Incisional Gastropexy: This technique relies on the
healing of the edges of a gastric seromuscular incision
to the edges of a peritoneum-transverse the abdominal
muscle incision for permanent gastropexy. The
incisional gastropexy was evaluated clinically in 44
dogs during a period of 5 years by (MacCoy et al.,1982)
with occasional surgical confirmation of adhesion and
with no reported recurrence.
Circumcostal Gastropexy: This technique relies on
the flaps of gastric seromuscular tissue brought
through a tunnel, which here is created behind the last
full rib. Experimental observations have confirmed the
formation significant adhesions with this technique
(Fox, 1985).
Tube Gastropexy/ Gastrostomy: Tube gastropexy
has the advantage of being quick to perform and
allowing gastric decompression post operatively.
Though easy to place , increased morbidity and longer
hospitilisation periods are associated with this
technique. A subcutaneous tunnel is made by means of
blunt dissection with long artery forceps, from a stab
incision in the skin lateral to the laparotomy wound, and
caudal to the last rib on the right. Foley’s catheter is
drawn into the abdominal cavity. It is introduced in the
stomach (pyloric antrum) after pre placing a purse
string suture.
L a p a ro s c o py A s s i s t e d G a s t ro p ex y : T h e
laparoscopic assisted gastropexy requires only a
minimal surgical approach using two small openings
www.veterinaryworld.org Veterinary World, Vol.3 No.12 December 2010
for entry of 5-10mm laparoscope and a laparoscopic
babcock forcep. This incisional gastropexy is strong
and is relatively quick and easy for a surgeon with entry
level laparotomy skills. (Rawlings, 2001). The initial
trocar canula is placed on the midline 2-3 cm caudal to
the umbilicus and is used for the viewing telescope.The
peritoneal cavity is distended with CO2 and the cranial
abdominal area is viewed with a 5-10mm laparoscope.
A 10mm trocar canula is inserted and a laparoscopic
babcock forcep is used to grasp the antrum of the
stomach. An incision is made through the serosa and
muscular layer of the antrum. A simple continuous
pattern of 2-0,synthetic,monofilament, absorbable
suture is placed to appose the seromuscular layer of
the antrum to the transversus abdominis muscle. After
viewing the gastropexy for position and orientation, the
laparoscope’s canula is removed and the incision is
closed.
Prevention of Recurrence
Smaller meals to be fed more frequently to avoid
excessive filling of stomach. Excessive exercise to be
avoided especially after meals are fed to the animal.
Consumption of large amount of water after exercise to
be avoided to prevent distension.
Conclusion
Gastric dilatation and volvulus is an abnormal
accumulation of gastric gas(dilatation),which may be
complicated by rotation of the stomach(volvulus) about
its mesentric axis.It is a life threatening emergency and
should be corrected within 4-6 hours of presentation.
Common in dogs with a long and deep chest
confirmation viz. Great Dane, German Shepherd,
IrishSetter, Saint Bernard. This condition may be acute
or chronic and has effects on the cardiovascular,
respiratory, haemopoietic and renal system. Typical
clinical signs include retching, unproductive vomiting,
cranial abdominal distension, circulatory collapse and
dyspnoea. Blood sampling, biochemical tests do not
show pathognomonic results. Hence surgery need not
be delayed results are obtained. Radiography can be
used to differentiate between simple gastric
obstruction and volvulus. Aggressive fluid therapy must
be started to stabilize the patient. Surgical options
include Tube, Incisional, Circumcostal and Belt Loop
Gastropexy. Frequent smaller meals should be fed and
minimum exercise allowed to prevent recurrence.
Laparoscopic assisted gastropexy can also be
considered as an emerging surgical option.
References
1. Betts, C.W., Wingóeld, W.E. and Greene, R.W. (1974):
A retrospective study of gastric dilation-torsion in the
dog.J Small Anim Pract 15:727.
2. Frendin, J. (1988): Gastric displacement in dogs
without clinical signs of acute dilatation.J Small Anim
556
 Gastric Dilation and Volvulus Syndrome in Dog
Pract 29:775.
3. Fox, S. M. (1985). Gastric Dilatation-Volvulus:Results
from 31 surgical cases of circumcostal gastropexy vs.
tube gastrostomy. Calif Vet 39:8.
4. Glickman, L.T., Lantz, G.C., Schellenberg, D.C. and
Glickman, N.W.(2000): Incidence of and breed related
risk factors for gastric dilatation and volvulus in dogs.J
Am Vet Med Assoc 216:40.
5. Hall, J.A., Solie, T.N., Seim, H.B. and Twedt,
D.C.(1993) : Gastric myoelectric and motor activity in
dogs with gastric dilatation-volvulus. Am J Physiol 265:
G646.
6. Hathcock, J.T.(1984) : Radiographic view of choice for
the diagnosis of gastric volvulus: the right lateral
recumbent view.J Am Anim Hosp Assoc. 20:967.
7. Horne, W.A. (1985) Effects of gastric dilatation
–volvulus on coronary blood flow and myocardial
oxygen consumption in the dog. Am J Vet Res. 46:98.
8. Lovett, W.L., Wangensteen, S., Glenn, T.M., and Lefer,
A.M. (1971):Presence of a myocardial depressant
factor in patients in circulatory shock. Surgery. 70:223.
********
www.veterinaryworld.org Veterinary World, Vol.3 No.12 December 2010
9. MacCoy, D.M., Sykes, G.P., Hoffer, R.E. and Harvey,
H.J. (1982). A gastropexy technique for permanent
fixation of the pyloric antrum. J Am Anim Hosp Assoc
207: 314.
10. Muir, W.W. (1982). Acid- base and electrolyte
disturbances in dogs with gastric dilatation-volvulus.J
Am Vet Med Assoc 181: 229.
11. Rawlings, C.A.,Foutz, T.L., Mahaffey, M.B., Howerth,
E.W., Bement, S. and Canalis, C. (2001). A rapid and
strong laparoscopic assisted gastropexy in dogs. Am J
Vet Res . 62:871.
12. Whitney, W.O., Scavelli, T.D., Matthiesen, D.T. and
Burk, R.L. (1989). Belt loop gastropexy : technique and
surgical results in 20 dogs. J Am Anim Hosp Assoc. 25:
221.
13. Williams, J.M. (1991). Gastric dilatation and volvulus.
BSAVA manual of Canine and Feline Abdominal
Surgery.1st ed. BSAVA ltd Co.,Gloucester. Pp : 80-95.
14. Wingfield, W.E.,Cornelius, L.M. and Ackerman, N.
(1975). Venous angiographic alterations seen in gastic
dilatation. J Small Anim Pract . 16:55.
557