Letters: An alternative gastrectomy technique?
In "Gastric dilatation-volvulus: Controlling the crisis" in the October 2012 issue, Dr. Eric Monnet listed two means of performing a gastrectomy. Given the few times I have seen this condition over the years, I am unlikely to have autostapling equipment. The 60% mortality associated with suturing a gastrectomy is not appealing, either.
I have heard a surgeon describe a suturing technique in which the necrotic section was simply inverted into the stomach lumen and inverting sutures were used to appose the healthy sides of the stomach, without actually incising the stomach. The technique resulted in a reduced risk of spilling the stomach contents, was fast (although not as fast as stapling), and, according to the surgeon, resulted in the necrotic section of the stomach simply sloughing off on its own over the next week without dehiscence. I have not had a chance to use this technique and wondered if Dr. Monnet had an opinion about it.
I also wondered if he had ever encountered stomach necrosis so severe that there was reason to put off the gastropexy until the gastrectomy site had healed. Could the gastropexy location be too close to the gastrectomy site that there could be concern for undue tension on the primary incision?Kirk Steinam, DVM
Manhattan Beach Animal Hospital
Manhattan Beach, CA 90266
Dr. Monnet responds: The invagination technique you describe above was published in the Textbook of Small Animal Surgery, 3rd ed., with no references, and textbooks are not peer-reviewed. Complications—bleeding or ulceration—have been reported only in case reports. There is no evidence-based medicine on the efficiency of this technique.
The impact of the technique on the survival of dogs with GDV is not known. A large segment of stomach getting necrotic and being autodigested has to have an effect on the gastrointestinal system, and possibly cause an inflammatory reaction and sepsis. It would be good to know the effect of this technique on the development of peritonitis and septic shock, for example, before it can be recommended for treating gastric necrosis during GDV.
I have never encountered a case of stomach necrosis so severe that gastropexy had to be delayed until the gastrectomy site had healed. The site of the gastropexy is far away from the area of necrosis. If the necrosis is so severe, it might affect the cardia, which then carries a poor prognosis.
Eric Monnet, DVM, PhD, FAHA, DACVS, DECVS