New Minimally Invasive Technique for Prevention of Gastric Dilatation Volvulus
Posted on July 5, 2009
A Great Dane comes into the ER with gastric dilatation volvulus. It’s a critical situation. Until recently, the only option to prevent this common emergency for most veterinarians was a gastropexy by ventral midline laparotomy.
But researchers at Iowa State University have developed a new, less-invasive option that can be quickly performed. The endoscopically assisted gastropexy is inexpensive, minimally invasive and takes about half as much time as if a traditional or laparoscopic prophylactic gastropexy were performed.
Gastric dilatation volvulus (GDV) in dogs is an acute and potentially fatal condition of uncertain etiology that results from a gastric malposition. It primarily affects large- and giant-breed dogs. The lifetime risk of certain predisposed dogs to develop GDV has been estimated to be 4% to 37%, with the Great Dane being at highest risk. Risk factors for developing GDV include breed, age, rapid eating, nervousness, and having a first-degree relative with a history of GDV.
The condition is considered an emergency and requires immediate surgical intervention. In dogs, GDV-associated mortality rate estimates range from 15% to 43%. If untreated, intragastric pressure will increase and, in turn, often result in cardiogenic shock and eventual death. Early recognition of the condition combined with rapid gastric decompression, appropriate treatment for hypovolemic shock and reperfusion injury, and management of cardiac dysrhythmias decreases the risk of death associated with the disease.
Medical treatment alone is inadequate and as many as 81% of affected dogs die within a year of initial treatment if surgery is not performed. Given the unacceptably high risk of recurrence without gastropexy, it is considered standard of care to perform that procedure at the time of surgical treatment of GDV. Prophylactic gastropexies have been increasingly advocated in the veterinary field. However, this has been met with mixed results by owners and possibly veterinarians due to the invasive nature of the procedure.
Until recently prophylactic gastropexy procedures had been performed via a ventral midline laparotomy. Advances in minimally invasive surgical techniques in the veterinary field led to the description of a laparoscopically assisted gastropexy. Such a technique minimizes the size of the incision, decreases incision related complications, and ultimately decreases patient morbidity. Unfortunately, laparoscopic equipment is not readily available to many veterinarians as is endoscopic equipment and it is generally expensive to use. Enter the endoscopically assisted gastropexy.
In theory, the endoscopically assisted gastropexy maximizes the benefits associated with minimally invasive surgery including reduced incision size, decreased postoperative pain and analgesic drug requirements, and more rapid restoration of normal intestinal tract function. Furthermore, it is less invasive than the laparoscopically assisted gastropexy. If you are interested in more information on this procedure, the full scientific article is published in the American Journal of Veterinary Research; Am J Vet Res. 2008 Apr;69(4):537-41. And for study notes about the disease, check out the VetPrep PowerPage included in this newsletter.
