Vet360 Vol 3 Issue 04 August 2016 | Page 32

SURGERY Article sponsored by Petcam ®
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 Heineke- Mikulicz 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 . vet360
Issue 04 | AUGUST 2015 | 32