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Surgery for GDV
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The immediate aim of surgery is
to return the stomach to its normal position and to evaluate it and the spleen
for signs of irreversible damage (such as tissue necrosis--cell death).
Long-standing or severe twisting may occasionally cause necrosis in portions
of the esophagus (the food canal down the throat)--if so, chances for survival
is poor.
If gastric perforation at any site (perforation of the organ wall) has
occurred, then the chances for survival is extremely poor, and euthanasia
should be seriously contemplated.
Barring any sign of irreversible damage, the veterinarian should perform
gastropexy (attaching a flap of stomach wall to an acceptable part of the
abdomen in order to help keep the stomach from twisting in the future.)
There are a number of techniques of gastropexy, and debate continues as
to which method is more effective.
The fact that there is still heated debate in the techniques indicates
that none is currently totally satisfactory.
Again, you may want to discuss it with your veterinarian before there
is an emergency. We will briefly describe a few of the more popular techniques
:
Prophylactic Gastropexy
One of the most effective means of preventing GDV is prophylactic gastropexy
- the surgical attachment of the stomach to the inside of the body wall.
Anchoring the stomach to the inside of the body wall does not prevent gastric
dilation (swelling with gas and fluid), but it should lessen its severity
and it should prevent a swollen stomach from twisting on itself.
Gastropexy has been shown to reduce the risk of recurrence of GDV by about
92% following a first episode and it is expected that it should be at least
as effective when performed on dogs at high risk of GDV before they ever
experience GDV
Prophylactic Gastropexy can now
be performed laparoscopicly for dogs at risk of bloating.
Performing the procedure using a laparoscope results in only 2 small incisions!
Anesthesia time is short, pain is minimal, and recovery is rapid. Owners
of high-risk dog breeds should consider discussing this option with their
veterinarian.
Tube gastropexy
A large balloon catheter is used to secure the stomach to the right abdominal
wall.
The catheter creates strong adhesions (fibrous scar tissues formed by
the body that join normally unconnected parts).
The tube must remain in place for 7 to 10 days following surgery.
The presence of the tube allows access to decompress the stomach if bloat
recurs during the first 10 days.
It also permits tube feeding if the dog refuses to eat for more than a
couple of days after surgery.
Tube gastropexy is the easiest and faster gastropexy technique, and is
often used in extremely weak dogs who may not survive an extended period
of being anesthetized.
The main argument against this technique is that it may not help keep
the stomach in place as well as some other gastropexy techniques.
The most common complications of tube gastropexy are premature tube loosening
and inflammation of the skin where the tube exits the abdomen.
Skin inflammation is usually caused by leakage of gastric contents around
the tube.
Occasionally, the balloon of the catheter becomes eroded by the acidic
gastric fluid, causing the tube to dislodge early.
This usually happens after 5 to 7 days as the dog becomes more active.
Typically, no further treatment is required.
However, if the tube dislodges during the first 48 hours, it may be necessary
to replace the tube to prevent the risk of contamination of the abdomen with
gastric juice.
Belt-loop gastropexy
A flap of the stomach wall is used to attach the stomach to the right abdominal
wall by braiding the stomach flap to strands of the abdominal wall.
This technique takes longer than the tube technique, but may create a
stronger bond.
However, argument against it is similar to that of the tube's--it may
not help keep the stomach in place as well as some other gastropexy techniques.
Circumcostal gastropexy
A flap of the stomach wall is used to attach the stomach to the last rib
on the right side.
The argument in favor of this technique is that the rib is a more rigid
and stable part of the anatomy, and will likely keep the stomach in place
better than the abdominal wall will.
There is a 5% chance of recurrence following gastropexy. Most of the recurrences
are simple dilation (bloat without torsion), and respond well to decompression
(passing of stomach tube).
However, a full blown recurrence of GDV may cause or follow the breakdown
of the gastropexy.
Therefore, medical and dietary management after GDV is important to help
prevent recurrence.
In addition to gastropexy, some veterinarians perform pyloroplasty to
help prevent recurrence of GDV.
Pyloroplasty
This is an operation in which the pylorus (the outlet from the
stomach) is widened to ensure the free passage of food into the intestine.
In clinical studies, researchers reported a much higher number of complications,
during the first week after surgery, in dogs that underwent this procedure
as compared to dogs that underwent gastropexy alone.
Post-Surgery Care and Common Complications
Some dogs may continue to have poor circulation and therefore shock despite
receiving large amounts of intra-venous fluids.
Some dogs may become anemic or hypoproteinemic (abnormally low protein
in the blood), and may require blood transfusion or plasma administration.
These dogs should be reevaluated frequently by the veterinarian. Cardiac
arrhythmia (irregular heartbeat) is common following an acute episode of
GDV.
The veterinarian should perform frequent EKGs to monitor the heartbeat
during the first week.
In fact, continuous EKG monitoring for 48 to 72 hours is required in acute
cases.
Anti-arrhythmic drugs may be necessary to treat this condition.
Gastric necrosis (cell death) and perforation can occur up to a week after
surgery, especially if resection (surgical removal of part or all of a diseased
organ) was performed.
The veterinarian must monitor the stomach fluids closely both during surgery
and during the first 5 days after surgery :
A pale green to gray fluid indicates arterial (blood vessel) damage caused
by ischemic (insufficient blood supply to an organ) or necrotic (dead cells)
regions which will require resectioning (surgical removal of part of the
organ).
A black or blue/black fluid suggest venous occlusion (blockage in the
veins that carry blood back to the heart) and intramural hemorrhage (internal
bleeding within the organ). Some of these lesions are not reversible.
Areas with compromised blood supply but do not require resection are dark
red.
Researchers also recommend that color be reevaluated 10 to 15 minutes
after repositioning and decompression of the stomach, before completing
the surgery. If gastric necrosis and perforation occurs, euthanasia
should be seriously considered.
Food and water is typically withheld for the first 48 to 72 hours after
gastropexy (bloat surgery), then multiple small meals are fed.
Once the dog returns home, he/she should be fed smaller-than-usual portions
of bland food frequently (3 times daily), and should not be exercised within
2 hours after meals.
Veterinary attention should be sought immediately if there are signs of
recurrence.
Prevention
There are no sure-fire ways to prevent or predict GDV.
Here is a list of suggestions :
Feed 2 or 3 smaller meals daily (as opposed to 1 large meal).
Feed no more than one cup per 33 pounds of body weight per meal when feeding
two meals a day
Feed an energy-dense diet, to reduce volume, but avoid a diet where a high
amount of calories are from fats.
Feed a variety of different food types regularly. The inclusion of
human foods in a primarily dry dog food diet was associated with a 59 percent
decreased risk of GDV while inclusion of canned pet foods was associated
with a 28 percent decreased risk
When feeding dry food, also include foods with sufficient amounts of meats
and meat meals, for example: beef, lamb, poultry, and fish.
Feed a food with larger particles, and include larger pieces of meat to
the diet. Some
veterinarians advocate the feeding of large pieces of fresh/raw fruits and
vegetables (e.g. apples, oranges, carrots) 3 to 4 times a week. The
reason is that commercial dog food lacks the appropriate amount of roughage
that a dog needs in order for the stomach to function properly.
Avoid moistening dry foods
If your dog eats rapidly, find
ways to try to reduce his speed of eating
Avoid raising the food bowl – place it at ground level
Any changes in the diet should
be made gradually, over a period of a week.
Vigorous exercise, excitement and stress should be avoided from 1 hour
before to 2 hours after meals. Stressful events have been reported to be
precipitating factors in GDV occurrence.
Excessive drinking should also be avoided. Avoid feeding food that are
known to cause flatulence (gas), e.g. soy, beans, peas, onions, beet pulp,
etc.
When you are not in close proximity to your dog, use a baby monitor to alert
you if your dog is in distress.
Learn to recognize signs of GDV, which include pacing and restlessness,
head turning to look at the abdomen, distention of the abdomen, rapid shallow
breathing, nonproductive attempts at vomiting, and salivation. These
symptoms can progress rapidly to shock and death. Get to your veterinarian
or emergency hospital the moment you suspect GDV
Gastropexy (surgery to prevent future torsion of the stomach) at the time
of surgical correction of GDV is recommended to prevent or minimize GDV re-occurrence
Discuss with your veterinarian the benefits and costs involved with a pro-phylactic
gastropexy before the dog ever experiences GDV
If you live far from veterinary care, have your veterinarian instruct you
in first aid measures to help your distressed dog while en route to the veterinary
hospital
Avoid breeding dogs who have had GDV and notify owners of first-degree relatives
of dogs who have had GDV to be especially alert.
Simethecone
Some people give their dogs over-the-counter anti-flatulent (Simethecone
products, such as Gas X®), just before or after they put their dogs through
stressful situations. It may also be handy when the dog appears to
have a lot of gas. Simethecone works by breaking down the surface
tensions of the small air bubbles in the stomach, thus causing bigger bubbles
to form, which theoretically, are easier for the stomach to pass.
On dogs known to be highly susceptible to GDV (e.g. ones that have already
bloated before) discuss the use of medicinal prevention (such as Metoclopramide
Hydrochloride, or Reglan®) with your veterinarian. The medicine is widely
used in human after abdominal surgery to combat painful intestinal flatulence.
It chemically decompresses the stomach and intestines, thus forcing the
gas out. Like all drugs, there are side effects, so the benefits and problems
of long term use should be carefully weighed and discussed with your veterinarian.
The above information is simply informational.
It's intent is not to replace the advice of a veterinarian nor to assist
you in making a diagnosis of your pet. Please consult with your own veterinarian
for confirmation of any diagnosis. Your pets life may depend on it.