Vet360, December 2016 - Page 30

CPD ACCREDITED ARTICLE Article sponsored by Petcam® tric wall with Metzenbaum scissors to the level of healthy gastric tissue. A two-layer closure with a continuous inverting suture pattern using 3-0 absorbable monofilament suture is necessary to close the stomach. This technique has been associated with a 60% mortality.22 If autostapling equipment is available, a gastrointestinal Postoperative Complications After surgery, monitor the dog for arrhythmias, DIC, hypotension, and peritonitis. All these complications result from the pathophysiology of GDV. Shock after surgery is usually caused by inappropriate treatment before surgery, blood loss during surgery, anesthesia effects, or fluid sequestration due to ileus. Septic shock can result from toxins and bacterial absorption from gastric mucosa necrosis and peritonitis. Negative prognostic indicators are gastrectomy with splenectomy, hypotension, DIC, arrhythmias, and peritonitis.9,15,20 Gastrectomy alone is not a prognostic indicator for survival, but it increases the risk of complications (peritonitis, arrhythmias, hypotension).15 4A. Gastric necrosis occurs along the greater curvature of the stomach in the body and the fundus. Automatic stapling equipment assists in removing the necrotic section. anastomosis device (GIA 50—Covidien) or a thoracoabdominal device (TA 90—Covidien) can be used to perform the gastrectomy (Figures 4A & 4B). Advantages of this technique include decreased risk of abdominal contamination from gastric spillage and decreased surgical time. Mortality rate with the autostapling equipment is close to 10%.23 Stomach rupture is associated with severe peritonitis that would require appropriate treatment. Gastropexy After gastrectomy, a gastropexy is required to stabilise the pyloric antrum on the right side of the abdominal cavity. Gastropexy substantially decreases the chance of recurrence—after a gastropexy, dogs can still dilate their stomachs but not rotate them. A belt-loop gastropexy and an incisional gastropexy are the two techniques most commonly performed. The modified incisional gastropexy with incorporation of the body of the stomach in the midline closure is not appropriate since it does not stabilise the pyloric antrum in the right side of the abdomen. If needed, a splenectomy is performed in a routine fashion. The abdominal cavity is then flushed with warm sterile saline solution and closed in a routine fashion. vet360 Issue 06 | DECEMBER 2016 | 30 Ventricular arrhythmias are common in patients with GDV, especially within 36 hours after surgery. They result from poo