Vet360 Vol 3 Issue 04 August 2016 - Page 32

Article sponsored by Petcam® SURGERY Gastropexy Gastropexy is the gold standard in preventing gastric dilatation volvulus form occurring or recurring. A gastropexy by definition, is the formation of a permanent adhesion from the stomach to the adjacent body wall. The most common indication for a gastropexy is to prevent gastric dilatation volvulus (GDV), however it is used in the treatment of hiatal hernias. Gastropexy for GDV is generally performed between the pylorus and the right body wall. There are a fair number of different techniques that can be performed. These are the circumcostal, belt loop, incisional, laparoscopic and tube gastropexy to name a few. The strength of the first two is nearly double that of an incisional. However these two take longer to perform and have increased associated discomfort and pain. Another important factor is to make the incision in the stomach through the seromuscular layers leaving only the mucosa intact. It is essential not to penetrate the mucosa. This can lead to motility disorders abscessation and draining tracts. The incision in the body wall should penetrate the muscle layer to ensure adequate adhesion formation. The two incisions should be around 4-5 cm in length. The same principles apply to the other techniques for performing gastropexy. Release abdominal wall incision traction or close the Balfour retractor; as this will allow anatomical apposition of the two sites For treatment of hiatal hernias a gastropexy of the fundus to the left body wall, an oesophagopexy and closure of the hiatus in the diaphragm are performed. Basic principles as for a pyloric gastropexy are applied here just a change in the position it is performed. Pyloroplasty and Pyloromyotomy Pyloroplasty is performed for alleviation of gastric outflow obstruction. The most commonly performed pyloroplasty performed is a Y-U pylorolasty. A full thickness Y shaped incision into the pylorus is made using basic principles. This is then closed in a U shaped closure, thus increasing the diameter of the outflow tract. A HeinekeMikulicz Pyloroplasty is simple to perform but will not increase the outflow tract as much as a Y-U. This is performed by making a full thickness longitudinal incision in the pylorus. This is then closed in a horizontal closure. A simple interrupted or continuous suture should be performed and not an inverting suture as this can decrease outflow tract diameter. A pyloromyotomy is simpler to perform but does not allow for inspection and taking of samples of the pylorus. It is performed by a partial thickness incision through the seromuscular layers leaving the mucosa intact. This is then left un-sutured to allow the pylorus to dilate. Its use is restricted to a handful of applications. Post-Operative Care It is advised to continue fluid therapy until the animal is eating and drinking. If there is a protracted period of anorexia expected post surgery then a feeding tube should be placed. An oesophagostomy tube is idea and simple to place after surgery. Oral intake should be initiated no longer than 7 hours post surgery. This is essential for healing of the intestinal system as eating stimulates stimulates peristalsis and aids in recovery. There is no need for postoperative antibiotics in gastrointestinal surgery, unless there was an established peritonitis prior to surgical treatment. No antibiotic will stop a leak in the intestinal system or treat the effects - they will only delay its discovery. The recommended protocol is pre-operative antibiotics 30 minutes prior to surgery then every hour during surgery. There is no evidence to justify continuing antibiotics after surgery. Any vomiting should be investigated as soon as possible as it can be an early sign of intestinal breakdown. In cases of vomiting it is indicated to l perform serial abdominal scans to check for free abdominal fluid and monitor the patients’ temperature for pyrexia. Prokinetic agents are useful post operatively and will often stop the vomiting caused by ileus. In cases of gastric invagination use of long-term proton pump inhibitors and coating agents are indicated. vet36 \YH UQT MH ̂U ͌UQT Mܚ[˚[ ̂ M ̍H LN B