Recently, veterinary surgeons have proposed using laparoscopic techniques to perform gastropexy with staples or sutures.1,4,6,10,12 Laparoscopic techniques result in less tissue trauma, decreased postoperative pain, and a faster return to normal function.10,12 Complications can be related to trocar placement (e.g. perforation of abdominal viscera or subcutaneous emphysema) or to increased abdominal pressure during abdominal insufflation.12 In addition, expensive laparoscopic equipment and advanced training are required.4,6,10,12
Incisional gastropexy is a fast, simple procedure that involves apposing the muscular layer of the gastric wall and the right
transverse abdominis muscle.1,3,5,8,11-14,16 This technique forms strong, long-term adhesions and results in few postoperative complications.1,5,8,12-14,16
TECHNIQUE FOR INCISIONAL GASTROPEXY
For general perioperative considerations when performing this procedure, including diagnostic testing, patient monitoring,
and postoperative support, please see the symposium introduction .
Prepare the patient from the xiphoid to the pubis, and perform a midline celiotomy. A nonsterile assistant can pass an orogastric
tube to facilitate gastric decompression in dogs with GDV. The surgeon can help guide the tube into the stomach by manipulating
it through the cardia and fundus as it is advanced. Once the stomach is decompressed, reduction of the volvulus is achieved
by pulling the pylorus ventrally and to the dog's right.
With the stomach in normal position, make a 4- to 5-cm incision through the seromuscular layer of the pyloric antrum, which
is located between the pylorus and the incisure (Figure 1). The incision should be parallel to the longitudinal axis of the stomach and midway between the greater and lesser curvatures
(Figure 2). The mucosa can usually be slipped away from the serosa and muscularis layers with digital pressure to avoid penetrating
the lumen during gastric incision (Figure 3).
Towel clamps can be placed full thickness through the right abdominal wall to evert the body wall and expose the peritoneum
(Figure 4). Make a 4- to 5-cm incision (equal to the length of the gastric incision), angling from craniodorsal to caudoventral, through
the peritoneum and superficial musculature of the right ventrolateral body wall, caudal to the last rib and 6 to 8 cm to the
right of midline (Figure 5). Appose the gastric and abdominal wall incisions with 2-0 or 0 monofilament suture in a simple continuous suture pattern.
Absorbable suture is recommended since fistula formation has been reported with the use of nonabsorbable sutures.4 Take bites in the craniodorsal portion of the abdominal wall and gastric incisions, and tie the initial knot, leaving the
knot end long. A hemostat can be attached to this end so it can be found easily as the closure is finished. Suture the dorsal
portions of both incisions together; when the caudal extent of the incision is reached, continue the suture pattern cranially
to appose the ventral portion of the incision (Figure 6). Tie the suture back to the long end of the cranial knot to finish the pattern (Figures 7 & 8).1,11