Page 160 - Clinical Manual of Small Animal Endosurgery

148 Clinical Manual of Small Animal Endosurgery

Gastropexy

Prophylactic gastopexy is performed to prevent gastric volvulus in large-
breed dogs that may be predisposed to developing gastric dilation and
volvulus (or GDV) syndrome. The laparoscopy-assisted gastropexy can
be performed at the same time as laparoscopic ovariectomy in female
dogs. In male dogs, when the procedure is performed at the same time
as castration, the surgeon may choose to perform an endoscopically
assisted gastropexy to avoid placement of an umbilical port. Biomechani-
cal studies of the forces required to disrupt the adhesion site following
minimally invasive approaches suggest that the adhesion is as strong as
intact stomach and clinical experience indicates that the gastropexy
performed with minimally invasive techniques is reliable and strong.
Although several techniques have been advocated, the one described by
Dr Rawlings and co-workers is technically easiest and most widely used
and will be described here (Rawlings et al., 2001, 2002).

Laparoscopy-assisted gastropexy
Ideally, 10 mm laparoscopic Babcock forceps and at least one 10 mm
trocar are needed for this procedure. Instruments of 5 mm can be used,
but they are not as robust in elevating the stomach to the body wall and
can result in more tissue trauma. Following general anaesthesia the
animal is positioned in dorsal recumbency. The abdomen is prepared for
aseptic surgery and widely draped, especially on the right side, just
caudal to the ribs. As with laparoscopic ovariectomy, the procedure
begins with open insertion of a 5 or 10 mm trocar cannula approximately
3 cm caudal to the umbilicus on ventral midline. This port serves as the
camera port during the procedure. The laparoscope is connected to a
camera and the camera is connected to a monitor. Surgeons view the
procedure on the monitor placed at the animal’s head. The abdomen is
distended with carbon dioxide and pressures are kept low to avoid com-
promising venous return and tidal volume. With the laparoscope inserted
in the sub-umbilical port, entry of a second 10 mm trocar is directly visu-
alised. The port is located approximately 3 cm caudal to the last rib just
lateral to the rectus abdominis muscle on the right side. Next, the 10 mm
Babcock forceps are inserted to elevate the liver lobes and expose the
ventral aspect of the stomach. If the stomach is incorrectly positioned
the Babcock forceps are used to reposition it in a normal location. A
point on the antrum of the stomach, approximately 5 cm cranial to the
pylorus, and midway between the greater and lesser curvature, is identi-
fied for the gastropexy. The Babcock forceps are used to grasp and
elevate the gastric wall and to move it to the base of the trocar cannula
(Fig. 5.10A). If there is considerable tension on the stomach, reducing
the intra-abdominal pressure may assist in this step. As the Babcock
forceps and cannula are withdrawn, the incision in the skin and abdomi-
nal fascia is extended to 4–6 cm. A muscle-splitting approach to the