WL PETS CORNER
A NEW PROCEDURE TO AID IN THE PREVENTION
OF TWISTED STOMACHS IN DOGS
by Dugie Gemmill, Parkside Veterinary Practice
Gastric dilation-volvulus (GDV) syndrome is a painful and life-
threatening condition in which the stomach becomes hugely
distended with gas and fluid and rotates on its axis, often through
180 0 to 360 0 . Gross gastric dilation can occur without rotation of the
stomach.
Any breed of dog may be affected but large and giant breeds are
predisposed – Great Danes, German Shepherds, Gordon and Irish
Setters, Bassett Hounds, Airedales, Wolfhounds, Weimeraners and
Rottweilers to name a few. A study found that 18% of all Great Dane
deaths were due to GDV (Evans and Adams 2010). The specific cause
is unknown but several risk factors beyond breed have been identified
(Glickman 2000); a high ratio between chest height and chest width
(deep-chested individuals), increasing age, having a first-degree relative
affected, speed of eating, using an elevated food bowl. Other factors
affecting incidence include male gender, low body weight, eating one
meal per day and a fearful or anxious temperament.
Dogs may present following a period of restless behaviour, non-
productive retching and hypersalivation. They will have a dramatic and
progressing distension of their abdomen. They may be pale, with a rapid
heart rate, breathing difficulties and may be collapsed.
Stretching of the stomach wall, and twisting, compromises the blood
flow to the wall, reducing oxygen supply which can lead to death of
the tissue. The spleen, which is attached to the stomach, can undergo
twisting or torsion as well, leading to similar effects. The dilated stomach
compresses the vena cava. Compression of this vein reduces the return
of blood to the heart from the abdomen and hind legs of the dog. The
dilated stomach presses on the diaphragm reducing its movement
and consequently the ability for the lungs to expand normally. The
circulatory and respiratory effects lead to a reduced supply of blood and
oxygen to tissues, resulting in shock and if untreated eventually death.
Treatment includes aggressive intensive care and fluid therapy to combat
the fatal effects of shock, decompression and if necessary, de-rotation
of the stomach. In some cases, removal of the spleen (splenectomy)
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or resection of part of the stomach (partial gastrectomy) is required.
Even with prompt treatment mortality rates can be high – published
results range from 10% (Brockman 1995) to 33% mortality (Mackenzie
2010). The prognosis is better where there is dilation but no twisting
(Brockman 1995). However, where gastrectomy and splenectomy are
required the mortality rate has been reported as high as 55% (Brourman
1996).
The incidence of gastric dilation and volvulus can be influenced
by selective breeding and management of feeding – avoid stress at
mealtimes, feed more than once per day, do not feed from a height,
slow down rate of eating. A gastropexy is a surgical procedure where
a permanent adhesion is created between the stomach and the body
wall. It is performed for the prevention of a gastric dilation and volvulus
(GDV) either in animals suffering from an episode of GDV or as a
preventative procedure. Dogs treated for GDV with de-rotation of the
stomach but no gastropexy had a recurrence rate of 50%, whilst those
treated with a gastropexy had a rate of less than 5% (Glickman 1997). A
study of five predisposed breeds (Great Danes, Irish Setters, Rottweilers,
Standard Poodles and Weimeraners).Ward, M.P (2003) found a reduced
lifetime risk of mortality ranging from 2.2-fold in Rottweilers to 29.6-
fold in Great Danes.
There are several different open abdominal techniques to achieve a
gastropexy, however these require significant exposure of the abdomen
to achieve the result. There are also laparoscopic-assisted procedures
where the surgeon uses a telescope and camera to identify and grasp
the stomach before suturing to a reduced abdominal incision up to 6cm
long. However, the gold standard procedure is to perform the procedure
entirely laparoscopically. While this technique requires significantly
more skill and experience on the part of the surgeon, in such hands the
comfort of the patient and recovery rate are much enhanced.
Laparoscopic gastropexy should be considered in at risk breeds. The
procedure can be performed as a single procedure in male dogs or at the
time of ovariectomy ovariohysterectomy in females.