Tuesday, October 22, 2013

Stomach Tacking

I have seen a few Great Danes come through the office lately, so I thought I would discuss stomach tacking (gastropexy).  Large breed dogs with deep chests (Great Danes, Irish Setters, Saint Bernands, etc) have a lot more room in the front part of their abdomen that allows for more movement in the stomach and ultimately makes them prone to gastric dilatation and volvulus (GDV or bloat).  

The exact cause of GDV is unknown, but many things can predispose to the condition including

1.) rapid eating
2.) eating one large meal daily
3.) overeating and overdrinking
4.) heavy exercise after eating
5.) conformation of the dog

A dog who has GDV will typically be anxious, may be drooling, have a distended abdomen, and are retching without producing anything.  The condition quickly becomes an emergency as the twisting of the stomach compromises blood return to the heart leading to shock.  The treatment involves immediate treatment of the shock (with fluids and pain medications) and then de-rotating the stomach.  Measures can be taken without surgery including passing a tube to deflate the stomach or passing a needle into the stomach through the body wall, but in most cases surgery will eventually be needed.  Even with surgery it is not guaranteed that the pet will pull through because if blood flow is compromised long enough you may get tissues that die and become infected.
X-ray image of stomach with GDV
The surgery involves deflating the stomach, placing the stomach back into normal anatomical position, and then permanently tacking the stomach to the body wall (which prevents recurrence of GDV).  There are many different procedures to tack the stomach; however, I typically perform a simple incisional gastropexy.  This involves making an incision into the outer portions of the stomach and then making a corresponding incision into the body wall.  The incision is then sutured together using two parallel lines of suture material.  The suture material will initially hold the stomach and body wall together, but eventually scar tissue will form and permanently hold the surgery site together.  If caught early enough, many dogs can do well; however some dogs may need more aggressive surgery (removal of a portion of the stomach, accompanying splenectomy) if the condition goes on long enough.
Tacking stomach to body wall
Because of deep chested breeds risk for GDV later in life, some owners may consider performing a preventative gastropexy.  This involves performing the gastropexy before a GDV occurs (typically done during a spay or neuter procedure).  There are some minimally-invasive techniques involving laproscopy, but not all veterinarians can perform these and the cost will likely be more.  A conversation about this procedure with your veterinarian should be made when the puppy is young, so a plan can be made for performing the gastropexy.