KEYHOLE SURGERY – MORE THAN JUST NEUTERING DUGIE GEMMELL OF MEDIVET WIRRAL
Minimally Invasive Surgery is an area in development within the veterinary world for the last twenty or so years, and although the number of practices offering the technique is small, it is increasing. I began my laparoscopic career in 2008 and gained my European qualification in the field in 2009. It has been said that getting old, makes you no wiser, but that over time some lessons have been learned. The main lesson learned from over a thousand laparoscopic procedures is that the simplest procedures can become complex, and conversely the most complex, are often simpler. Experience is learning to see the wood within the trees.
The most common procedure performed is a laparoscopic neuter of female dogs – either anovariectomy( removing only the ovaries) or ovariohysterectomy( removing both the ovaries and the womb). However, with training and practice, a surgeon’ s expertise can extend beyond merelyneutering. We routinely remove retained abdominal testicles from male dogs( cryptorchidectomy). The smallest I have found was only four millimetres in size! We can explore the whole abdomen in detail and accurately biopsy tissues, such as the kidneys, liver, and pancreas, laparoscopically. We can remove some adrenal gland tumours( adrenalectomy) in dogs with Cushing’ s Disease and perform cholecystectomies( removal of the gall bladder). The latter is one of the most common human laparoscopic procedures.
In the clinic the staff often joke about how long I can speak to a client about laparoscopic surgery. Indeed, I sometimes find myself surprised that even after seventeen years of experience it is a topic I am incredibly passionate about. However, information, if is valuable or beneficial should always be passed on! I want to talk a little about a procedure( the gastropexy) performed to help prevent a serious and potentially fatal condition in large and giant breed dogs. 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. Gastric dilation or“ bloat” 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, Rhodesian Ridgebacks, Rottweilers, and Spinones to name a few. A study found that 18 % of all Great Dane deaths were due to GDV. The specific cause is unknown but several risk factors beyond breed have been identified a high ratio between chest height and chest width( deep-chested individuals), increasing age, having a first-degree relative( a mother, father, or litter mate) 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. What do we see clinically, as vets? Patients may present following a period of restless behaviour, non-productive retching, and drooling. They will have a dramatic and progressing distension of their abdomen. The patient 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 largest vein in the abdomen, 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) or resection of part of the stomach( partial gastrectomy) may be required. Even with prompt treatment mortality rates can be high – published results range from 10 % to 33 % mortality. The prognosis is better where there is dilation but no twisting. However, where gastrectomy and splenectomy are required a mortality rate as high as 55 % has been reported.
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 %. A study of five predisposed breeds( Great Danes, Irish Setters, Rottweilers, Standard Poodles and Weimeraners). found a reduced lifetime risk of mortality ranging from 2.2-fold in Rottweilers to 29.6-fold in Great Danes.
It is not often that I make grand statements, however laparoscopic gastropexy should be considered in at risk breeds of dog. The procedure can be performed as a single procedure in male dogs or at the time of spaying in females.
2 Sefton Road, New Ferry, Wirral, CH62 5AT T: 0151 644 8918 E: new. ferry @ medivet. co. uk
906 New Chester Road, Bromborough, Wirral, CH62 6AU T: 0151 334 1355 E: bromborough @ medivet. co. uk
27 Daryl Road, Heswall, Wirral, CH60 5RD T: 0151 342 7646 E: heswall @ medivet. co. uk