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LAPAROSCOPIC SURGERY – MORE THAN JUST NEUTERING !
BY DUGIE GEMMILL , PARKSIDE VETERINARY PRACTICE
Laparoscopic or Minimally Invasive Surgery is an area in development within the veterinary world for the last twenty or so years .
I feel my age when I realise , I gained my European qualification in field as long ago as 2009 ! The most common procedure performed is a laparoscopic neuter of female dogs – either an ovariectomy ( 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 merely neutering . Here at Parkside , 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 .
However , I want to talk a little about a procedure ( the gastropexy ) performed to help prevent a serious 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 , often through 1800 to 3600 . 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 ) 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 . This last technique is the one used at Parkside . 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 .
Dugie is a graduate of Glasgow University and has worked at Parkside Veterinary Practice since 1990 and has been the Clinical Director for the last seven years . He has a keen interest in laparoscopic and orthopaedic surgery .
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