Ch 91 Stomach Flashcards
Fox-Alvarez JAVMA 2019
Evaluation of a novel technique involving ultrasound-guided, temporary, percutaneous gastropexy and gastrostomy catheter placement for providing sustained gastric decompression in dogs with gastric dilatation-volvulus
To evaluate the feasibility of ultrasound-guided, temporary, percutaneous T-fastener gastropexy (TG) and gastrostomy catheter (GC) placement for providing sustained gastric decompression in dogs with acute gastric dilatation- volvulus (GDV) and to compare findings with those of trocarization.
ANIMALS 16 dogs with GDV.
PROCEDURES Dogs were randomly assigned to undergo gastric decompression by means of percutaneous trocarization (trocar group; n = 8) or temporary TG and GC placement (TTG+GC group; 8) with ultrasound guidance. The gastric volvulus was then surgically corrected, and the decompression sites were examined. Outcomes were compared between groups.
RESULTS The proportion of dogs with successful decompression did not differ significantly between the TTG+GC (6/8) and trocar (7/8) groups; median procedure duration was 3.3 and 3.7 minutes, respectively.
After the failed attempts in the TTG+GC group, the procedure was modified to include ultrasound guidance during T-fastener placement. The decrease in intragastric pressure by 5 minutes after trocar or GC insertion was similar between groups. For dogs in the TTG+GC group, no significant difference in intragastric pressure was identified between 5 and 60 minutes after GC insertion. Complications included inadvertent splenic or jejunal placement in 2 dogs (TTG+GC group) and malpositioned and ineffective trocar placement in 1 dog (trocar group). All dogs survived for at least 2 weeks.
CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided, temporary, percutaneous TG and GC placement was safe and effective at providing sustained gastric decompression in dogs with GDV, suggesting that this technique would be ideal for dogs in which surgical delays are anticipated or unavoidable.
White JAVMA 2021
Evaluation of a staged technique of immediate
decompressive and delayed surgical treatment
for gastric dilatation-volvulus in dogs
RESULTS 6 dogs underwent corrective surgery in the same anesthetic session as for decompression and stabilization, 2 of which had gastric necrosis.
Thirty-five dogs underwent corrective surgery in a second anesthetic episode a mean of 22.3 hours (range, 5.25 to 69.75 hours) after presentation, during which gastric necrosis was identified in 2 dogs.
The mortality rate for delayedsurgery patients was 9% (3/35).
Time from presentation to surgery was not associated with surgeon subjective assessment of gastric health status or mortality rate.
Intraoperative identification of gastric necrosis was associated with nonsurvival.
Single plasma lactate concentrations and percentage change in serial lactate concentrations were associated with intraoperative gastric health status and mortality rate.
CONCLUSIONS AND CLINICAL RELEVANCE The observed mortality rate for delayed-surgery patients was comparable to rates reported for other GDV treatment techniques. Results suggested that delaying corrective surgery is possible for certain dogs, but careful case selection would be important and no reliable preoperative case selection criteria were identified. Additional research is needed to further investigate the potential risks and benefits of staged versus immediate surgical treatment of GDV in dogs.
Elmenhorst JSAP 2020
Retrospective study of complications
associated with surgically-placed
gastrostomy tubes in 43 dogs with
septic peritonitis
Retrospective analysis of 43 dogs with septic peritonitis that had undergone surgical exploration and gastrostomy tube (de Pezzer or Foley) placement as part of the surgical procedure. Postoperative recovery times, hospitalisation times, complication rates and overall survival times were documented.
Results: The most common cause of septic peritonitis was dehiscence of an enterotomy or enterectomy site.
Fifteen dogs had a Foley gastrostomy tube placed and 28 had a de Pezzer gastrostomy tube placed.
The median time from surgery to the start of enteral nutrition was 16 hours (range 3 to 28 hours). There were no major complications relating to the gastrostomy tube; minor complications occurred in 11 (26%) patients.
[The most common complication, occurring in 10 patients, was discharge around the tube site. No major complications were identified in any of the patients. When analysing the Foley tubes and de Pezzer tube separately, the complication rates was 13% (two of 15) and 32% (nine of 28), respectively. Two of the patients with de Pezzer tubes additionally experienced more specific tube-related complications. One of the dogs prematurely removed the entire feeding tube 8 days after surgery but, following monitoring, there was no clinical suspicion of gastric content leakage into the abdominal cavity, and no further intervention was required. The second dog experienced a complication at the time of tube removal when the tip of the tube separated and remained in the stomach. Conservative management was deemed the most appropriate. The owners were advised to monitor the faeces for passage of the tip. The tip passed through the gastrointestinal tract without any further complication or intervention.]
The overall median time spent in hospital was 5 days (range 3 to 29 days) for patients surviving to discharge and 22 (51%) dogs survived overall.
Clinical Significance: Gastrostomy feeding tubes provide a safe way to provide enteral nutrition to dogs with septic peritonitis; they are associated with a low complication rate in these patients.
Griffin Vet Surg 2020
Percutaneous radiologically guided gastrostomy tubes:
Procedural description and biomechanical comparison
in a canine model
Objective: To describe the novel placement of percutaneous radiologically
guided gastrostomy (PRG) tubes in a canine cadaveric model and to biomechanically
compare PRG and percutaneous endoscopic gastrostomy (PEG)
tube constructs.
Study design: Descriptive and biomechanical experimental study.
Animals: Fifteen large breed (>25 kg) canine cadavers.
Methods: Percutaneous endoscopic gastrostomy tubes, low-profile PRG tubes,
and standard PRG tubes were each placed in five canine cadavers. Body wall
and stomach (with attached gastrostomy tube constructs) were harvested and
biomechanically tested. Data regarding the maximal load to failure and procedure
time were statistically analyzed.
Results: Percutaneous endoscopic gastrostomy and PRG tube placement was
successful in all cadavers with no procedure-related complications.
Gastrostomy tube placement time was longer for the PEG group vs the lowprofile
PRG (P = .005) and standard PRG (P = .037) groups. Peak construct
strength was lower for the PEG group vs the low-profile PRG (P = .002) and
standard PRG (P = .010) groups. The site of failure varied among groups.
Conclusion: Percutaneous radiologically guided gastrostomy tubes were successfully
placed in all cases with shorter placement time and greater peak construct
strength compared with PEG tubes.
Clinical significance: Due to the increased load to failure as well as
decreased placement time recorded for PRG tubes relative to PEG tubes, PRG
tubes may be considered as an alternative minimally invasive gastrostomy
option in large breed canine patients. Further evaluation in clinical animals is
required.
Duffy Vet Surg 2021
Evaluation of staple line reinforcement after partial
gastrectomy closure in an ex vivo canine model
Partial gastrectomy constructs were assigned to one of three closure techniques (n = 8 per group): group 1, stapled closure with a 90-mm thoracoabdominal stapling device and a 4.8-mm staple cartridge; group 2, hand-sewn double-layer inverting suture closure with 3-0 glycomer 631; and group 3, staple line reinforcement with an inverting Cushing suture pattern. Leakage and pressure testing were performed. Initial leakage pressure (ILP), maximal leakage pressure (MLP), and leakage location were recorded. Significance was set at P < .05.
Results: Placement of a Cushing suture (group 3) increased ILP and MLP by 3.2-fold and 2.8-fold, respectively, compared with stapled closures alone (P < .001).
Constructs closed with double-layer suture closure reached ILP and MLP 4.5-fold and threefold greater, respectively, compared with those with stapled closures alone (P < .001).
Maximal leakage pressure did not differ between groups 2 and 3 (P = .14). Leakage occurred from the inverting suture line in all constructs of groups 2 and 3 and from staple holes in six of eight group 1 constructs.
Conclusion: Double-layer suture closure of canine partial gastrectomies achieved superior biomechanical properties compared with stapled closure techniques.
Reinforcing staple closures with an inverting suture line improved resistance to leakage.
Clinical significance: Reinforcing single-layer closure of partial gastrectomies with an inverting Cushing pattern is recommended to improve resistance to leakage. In vivo investigation is warranted to evaluate influence of closure technique on gastric healing, postoperative stasis, ischemic injury, and postoperative dehiscence.
Lhuillery Vet Surg 2021
Outcomes of dogs undergoing surgery for gastric dilatation
volvulus after rapid versus prolonged medical stabilization
Sample Population: One hundred and sixty-two dogs with GDV.
Methods: Dogs presenting with a GDV were allocated to 1 of 2 groups, immediate or delayed. In the immediate group, dogs were stabilized for 90 min prior to undergoing surgery. In the delayed group, dogs underwent surgery after at least 5 h of stabilization. Medical stabilization included gastric decompression and placement of an indwelling nasogastric tube to prevent further gastric dilatation in all dogs. Short-term outcomes were compared between surgical timings by univariate and multivariate analyses.
Results: Dogs (n = 89) in the immediate group underwent surgery a median time of 2.1 h after presentation (range 1.9-2.5 h), whereas those in the delayed surgery group (n = 73) were operated a median time of 9.8 h (range 5.4-13.7 h) after presentation.
Survival rates did not differ between dogs undergoing immediate or delayed surgery at discharge (70/89 and 60/73, respectively) or at 1 month postoperatively (68/89 and 55/73, respectively).
The degree of gastric torsion was differently distributed between the 2 groups (P = .05). In the immediate group, 19, 52, and 9 dogs had a 0 , 180 and 270 gastric torsion respectively, whereas in the delayed group, 27, 32, and 5 dogs had a 0 , 180 and 270 gastric torsion respectively.
Hyperlactatemia 24 h after initiation of fluid therapy was associated with an increased in-hospital mortality risk and at 1 month postoperatively.
Conclusion: No survival benefit was detected as a result of proceeding to surgery after either a rapid or a prolonged medical stabilization.
Clinical Significance: The aggressive stabilization and monitoring protocol described here can be considered as an alternative to stabilize dogs with GDV prior to surgery within 13.7 h of presentation. Further research is required to investigate the potential risks and benefits of prolonged over rapid stabilization and to identify candidates for each approach.
Vet Surg 2019
Perioperative complications and outcome after surgery for
treatment of gastric carcinoma in dogs: A Veterinary Society of
Surgical Oncology retrospective study of 40 cases (2004–2018)
40 dogs
Results: Surgical treatment included partial gastrectomy (28 dogs), Billroth I (9 dogs), subtotal gastrectomy (2 dogs), and submucosal resection (1 dog).
Major postoperative complications occurred in 8 of 40 dogs, including septic peritonitis secondary to dehiscence in 4 dogs.
The median progression free interval was 54 days, and the median survival time (MST) was 178 days (range, 1–1902).
According to multivariable analysis results, experiencing an intraoperative complication was associated with an increased risk of death (hazard ratio [HR] 3.5, 95% CI 1.1–9.8, P = .005), and administration of adjuvant chemotherapy correlated with an improved survival (HR 0.4, 95% CI 0.2–0.9, P = .03).
Conclusion: In this population of dogs, MST exceeded historically reported data, major postoperative complication rates were comparable to established literature, and administration of adjuvant chemotherapy was associated with improved survival.
Bahlmann JFMS 2022
Gastric diverticula in six cats:
a case series (2011–2020)
Case series summary Gastric diverticulum (GD) is a rare condition that is described adequately in humans but has not been reported in cats. This case series describes six cats with GD, including three that were published in a previous abstract. All cats presented for a variety of gastrointestinal disorders, including chronic vomiting, weight loss and anorexia, and underwent negative contrast radiography to diagnose GD. All but one cat underwent surgical resection of the GD via partial gastrectomy, while the remaining cat was euthanized. Resection of the GD was associated with reduction of reported clinical signs. Relevance and novel information Gastric diverticula have never been reported in the cat. Negative contrast radiography appears to be a superior imaging technique in the diagnosis of feline GD. In cats with a vague chronic history, including vomiting, anorexia and weight loss, GD should be considered among the differential diagnoses. Further study and more cases need to be identified to better assess clinical problems referable to GD in the absence of other comorbidities. Maine Coon cats with GD appear to be over-represented.
Lotti JSAP 2021
Effect of two different pre-anaesthetic omeprazole protocols on gastroesophageal reflux incidence and pH in dogs
Fifty-five dogs undergoing elective ovariectomy were randomly assigned to: omeprazole single dose 1 mg/kg orally the evening before anaesthesia (20 dogs), omeprazole two doses 1 mg/kg orally the evening and 3 hours before anaesthesia (15 dogs), and control group that did not receive omeprazole (20 dogs).
An oesophageal impedance/pH probe was used to measure gastroesophageal reflux incidence and pH during anaesthesia.
Results: Gastroesophageal reflux was observed in 55% (11/20) of control dogs, 55% (11/20) of dogs receiving omeprazole once and 47% (7/15) of dogs receiving omeprazole twice. The incidence was not statistically significant different between groups.
Gastroesophageal reflux pH (mean ± sd) was higher in dogs receiving omeprazole twice (6.3 ± 1.5), when compared to either control dogs (3.8 ± 1.1) or dogs receiving omeprazole once (4.1 ± 1.5). Strongly acidic reflux (pH < 4) was observed in 7% (1/15) of dogs receiving omeprazole twice versus 55% (11/20) and 35% (7/20) of control dogs and dogs receiving omeprazole once, respectively.
Clinical Significance: Omeprazole administered the evening and 3 hours before anaesthesia increased gastroesophageal reflux pH and decreased the incidence of strongly acidic reflux in dogs. A single dose of omeprazole given the evening before anaesthesia had no effect on reflux pH.
Treggiari JSAP 2022
Canine gastrointestinal stromal tumours treated with surgery
and imatinib mesylate: three cases
(2018-2020)
Dogs with a diagnosis of GIST previously confirmed with histopathology and immunohistochemistry were considered for inclusion. Medical records were reviewed for clinical signs at presentation, results of diagnostic tests, tumour location and treatment. To be included, patients had to undergo staging procedures and treatment with imatinib alone or in combination with surgery. Immunohistochemistry and KIT mutational analysis were performed assessing all included cases.
R
esults: Three cases were included. All cases underwent staging procedures and surgical excision. Tumours were located in the stomach (two cases) or caecum (one case). KIT mutational status was assessed and the presence of a 54-base pair deletion in exon 11 was identified in one case. Following surgery, imatinib was used to treat recurrent, metastatic or residual disease and resulted in complete response and stable disease in the macroscopic setting and no evidence of recurrence in the microscopic setting. Follow-up time was 890, 120 and 352 days, respectively.
C
linical Significance: Surgical and medical treatment resulted in a positive outcome in these cases of canine GIST. Imatinib treatment was well tolerated and resulted in a measurable response and a low spectrum of toxicities. Further studies on the tolerability and efficacy of imatinib in solid tumours and GIST are warranted to define its effectiveness and safety.
Pan and Mann JAVMA 2023 separate papers
Paper 1 - Addition of two full-thickness simple interrupted sutures to standard incisional gastropexy increases gastropexy biomechanical strength
Paper 2 - Comparison of incisional gastropexy with and without addition of two full-thickness stomach to body wall sutures
RESULTS - Cadaver study on pigs
The MIG had higher failure load and work to failure compared to SIG. All failures were caused by gastric tissue tearing.
CLINICAL RELEVANCE
The MIG is biomechanically superior to SIG and may provide more security than SIG during healing. However, clinical study is needed to ascertain if there is a difference in gastropexy failure and complications between these 2 techniques.
RESULTS - clinical study
There were no significant differences in overall complication rates between SIG and MIG.
CLINICAL RELEVANCE
Surgeons who feel that engagement of gastric submucosa is important for gastropexy success may use the MIG technique with minimal fear of complications. However, superiority of one technique over the other cannot be determined on the basis of this study.
Singh/Hawker JAVMA 2023
Laparoscopic surgical treatment for sliding
hiatal hernia is associated with an owner-perceived
improvement in clinical outcome in dogs
RESULTS - 9 dogs
Intraoperative pneumothorax occurred in 5 of 9 (55.6%) dogs and resulted in conversion to open celiotomy in 2 (22.2%) dogs. In 4 dogs, pneumothorax was suspected to be the result of progressive leakage of capnoperitoneum through the suture bite holes of the esophageal hiatal plication sutures. Hiatal plication was performed using intracorporeal simple interrupted sutures (n = 4) or a simple continuous pattern with barbed suture (4). Esophagopexy was performed using barbed suture in all dogs. Gastropexy was performed using a total laparoscopic technique (n = 4) or laparoscopic-assisted technique (3). Using a standardized questionnaire, dog owners perceived a postoperative improvement in regurgitation after eating and regurgitation after excitement/increased activity.
CLINICAL RELEVANCE
Laparoscopic treatment of SHH resulted in owner-perceived improvement in clinical signs. Intraoperative pneumothorax occurred in a high proportion of dogs but did not result in long-term sequelae.
Velay JAVMA 2023
Safe gastric wall closure in dogs using a single-layer full-thickness simple continuous suture pattern
ANIMALS 60 dogs that underwent gastrostomy for foreign body removal, with 20 dogs in each group. METHODS Dogs treated with gastrotomy from January 1, 2018, to January 1, 2023, were randomly assigned to groups based on the suture pattern used at the gastrotomy site. Gastrotomies were closed with a double-layer inverting continuous pattern (DLI) in the DLI group. Gastrotomies were closed using a double-layer simple continuous pattern (DLS) in the DLS group. Gastrotomies were closed with a full-thickness single-layer simple continuous pattern (SLS) in the SLS group. RESULTS All dogs were discharged from hospitalization. The survival rate did not differ among the 3 groups 1 month postoperatively, and major complications were not observed. CLINICAL RELEVANCE Using a full-thickness single-layer pattern is a safe alternative for gastrotomy closure.
Baron Vet Surg 2020
Paramedian incisional complications after prophylactic
laparoscopy-assisted gastropexy in 411 dogs
Records for dogs that underwent single-incision–port laparoscopyassisted
gastropexy (SIPLAG) or multiple-port laparoscopy-assisted gastropexy
(MPLAG) at five veterinary referral hospitals were reviewed
Results: Paramedian incisional complications were observed in 78 of
411 (19%) dogs. The most common complication was seroma formation, which
occurred in 51 (12.4%) dogs. Surgical site infections were observed in 16 (3.9%)
dogs, and dehiscence or development of excessive scar tissue at the incision
site were each observed in nine (2.2%) dogs. Complications resolved with conservative
treatment in 75 of 78 (96.2%) dogs and with surgical treatment in
three of 78 (3.8%) dogs. The odds of complications were approximately twice
as high in dogs undergoing SIPLAG than in dogs undergoing MPLAG (odds
ratio, 2.03; P = .006).
Conclusion: Minor paramedian incisional complications, particularly seroma
formation, were frequently observed after LAG. Most complications were successfully
managed conservatively. Single-incision–port laparoscopy-assisted gastropexy
was associated with a higher complication rate compared with MPLAG.
Clinical significance: Owners should be informed that there is a relatively
high rate of minor paramedian incisional complications after LAG. The risk of
complications appears to be higher for SIPLAG than for MPLAG.
Lacitignola Vet Surg 2021
Absorbable fixation straps for laparoscopic
gastropexy in dogs
Methods: The pyloric antrum was affixed to the abdominal wall laparoscopically by applying a series of straps. The cadaveric study assessed potential challenges during the procedure and stomach mucosal penetration. For the clinical study, the total duration of surgery, time to complete the gastropexy, and the number of straps used were recorded. Ultrasound evidence of adhesion, complications, and weight were monitored at 7, 30, and 90 days after surgery. Owner satisfaction was evaluated at the 6-month follow-up. Results: The total duration of surgery was 25.8 minutes (range, 19-39; SD, 6.7), and the time to complete the gastropexy was 10.1 minutes (range, 7-19; SD, 3.9). The linear regression analysis revealed an inverse correlation between the time to complete the gastropexy and the order of the surgeries (r2 = 0.75, P < .05). No complications were recorded. Ultrasound examination was used to confirm gastropexy at all follow-ups. Conclusion: Laparoscopic gastropexy with AFS was performed in both cadavers and clinical animals with minimal complications. Persistent adhesion was demonstrated during ultrasound evaluations and in one postmortem evaluation. Clinical significance: This novel laparoscopic technique can be employed safely, effectively, and reasonably quickly, and the learning curve is expected to be relatively short.
Mullen Vet Surg 2024
Use of real-time near-infrared fluorescence to assess
gastric viability in dogs with gastric dilatation volvulus:
A case-control study
surgeon’s subjective assessment (viable or nonviable) of gastric viability of the cardia, fundus, body, and pylorus was made 10 min following derotation on the basis of serosal color, palpable thickness, gastric motility, and gastric and gastroepiploic arterial pulsations. Once the surgeon’s subjective assessment was recorded, 0.1 mg/kg of indocyanine green (ICG; 2.5 mg/mL)16 was administered IV followed by 3 mL of 0.9% NaCl flush by the anesthetist. Real-time qualitative images of the fluorescing gastric vasculature in the cardia, fundus, body, and pylorus were obtained. Based on the distribution of vascular fluorescence alone (presence or absence of visualization of defined blood vessels), the cardia, fundus, body, and pylorus were each recorded to be viable (Figure 1A) or nonviable (Figure 1B).
Results: Subjective assessment diagnosed 17 viable and three nonviable GDVs (2 fundi; 1 cardia).
Near-infrared imaging demonstrated nonviable gastric fluorescence in 4 dogs (3 fundi/cardia; 1 fundus).
The surgeon’s margins for resection were altered in 3/20 dogs.
Fluorescence intensity (cardia, fundus, body, pylorus) was lower in GDV viable (30.59%, p = .04; 38.17%, p < .01; 51.18%, p < .01; 44.12%, p= .01) and nonviable (11.00%, p < .01; 4.33%, p < .01; 57.67%, p = .22; 54.33%, p = .72) dogs compared to healthy controls (44.7%, 70.05%, 84.00%, 63.95%).
Fundic fluorescence was less in nonviable gastric tissue in comparison with viable gastric tissue (p = .03).
Fluorescence of the gastrectomy staple line approximated that of viable tissue.
Conclusion: Near-infrared fluorescence can identify histologically confirmed nonviable gastric tissue.
Clinical significance: These results provide enough evidence to support the implementation of NIRF as an adjunct to gross examination of the gastric wall in dogs with GDV
