Minimally invasive gastropexy; which is best?

Overview

Gastric dilatation-volvulus (GDV) is a life-threatening medical and surgical emergency. The acute crisis is characterized by severe gastric distention and volvulus, which compresses critical vasculature, causing gastric ischemia, impaired venous return and poor cardiac output. This leads to hypovolemic shock, myocardial ischemia, cardiac arrhythmias, electrolyte imbalance, and visceral necrosis among other detriments.

Large and giant-breed dogs, underweight dogs, and dogs with a large thoracic depth to- width ratio have a greater risk of developing gastric dilatation-volvulus. This risk increases with age. Large and giant purebred dogs have a 24% and 21.6% lifelong chance of developing GDV respectively [Glickman et al. 2000]. Further, certain breeds such as the Great Dane have up to a 40% life-time risk of developing GDV. Consequently, preventative procedures such as gastropexy are commonly performed in veterinary practice.

Gastropexy is an effective surgical procedure that creates a permanent adhesion between the pyloric antrum and the right abdominal wall, preventing gastric volvulus. Because prophylactic gastropexy has traditionally required a large celiotomy in otherwise healthy dogs, several minimally-invasive gastropexy methods have been described including: endoscopically-assisted, laparoscopic-assisted, laparoscopic and radiologicassisted. Ultimately, all of these techniques create an incisional gastropexy which has been demonstrated to be both biomechanically and clinically effective in dogs at risk for GDV. However, these techniques utilize different instrumentation (e.g. laparoscope versus endoscope or fluoroscopy) and approaches to create the incisional gastropexy. Presumably the impetus for development of these minimally-invasive techniques has been to reduce tissue injury, pain and wound complications. It is well accepted that minimally-invasive alternatives to open surgery are by nature, less injurious to tissues and therefore less prone to cause postoperative pain and wound complications. However, the technical ease and efficiency of these different minimally-invasive procedures is also a factor for consideration. Although there are currently many minimallyinvasive options for gastropexy described, there is a lack of comparative analysis between techniques. All this considered, it is possible to make assessments regarding the relative pros and cons of individual techniques based on the current literature and clinical experience with these procedures. [...]