Incisional Gastropexy Technique

Gastropexy for treatment of Gastric Dilatation Volvulus is often performed as an emergency procedure; therefore, an ideal method for gastropexy should be quick, safe and easy to perform. This article describes an incisional gastropexy technique designed to be readily performed by a surgeon without assistance. Like other successful permanent gastropexy techniques, this method apposes incised surfaces of the right abdominal wall and pyloric antrum. Illustrated technical details are included that allow the surgeon to readily create these incised surfaces while avoiding potential complications such as inadvertent perforation of the gastric mucosa or diaphragm. In addition, standard gastropexy incision sites are described and shown to help prevent gastric malpositioning or outflow obstruction following surgery

Surgery Technique

With the animal in dorsal recumbency, aseptically prepare the ventral abdomen 10 centimetres cranial to the xiphoid extending to the pubis. The surgeon stands on the left side of the patient for the best exposure to the gastropexy site; the figures in this article are shown from this perspective. Therefore, the cranial aspect of patient shown in the series of images is to the right. Create a linea alba incision from the xiphoid to umbilicus. This incision should be long enough to perform gastropexy and allow complete abdominal exploration. If more cranial exposure is needed in deep-chested dogs, continue to cut the linea incision (cranial but superficial to the xiphoid cartilage) with Mayo scissors. The falciform fat should be removed to help access the abdominal wall gastropexy site. If the gastropexy is done to treat, rather than prevent GDV, decompress the stomach and reposition the antrum to its normal location. Evaluate the stomach for evidence of necrosis after repositioning. Resect or invaginate necrotic stomach wall, as the surgeon prefers. Evaluate the spleen for irreversible changes, such as necrosis or venous thrombosis, and perform a splenectomy if necessary. Explore the entire abdomen and correct any problems encountered before performing the gastropexy.

Grasp the right side of the cranial wall incision, evert and roll the wall to allow palpation of the chondral aspect of rib twelve. The twelfth rib can be identified by palpating its cartilaginous margin that ends several centimetres caudal to the xiphoid cartilage. The reader should note that there are individual breed differences in the location of the chondral aspect of ribs eleven and twelve. The eleventh rib can be used alternatively if the cartilaginous end of the rib is located several centimetres caudal to the xiphoid. Isolate the twelfth rib with your thumb and index finger and pull the rib away from deeper structures. Place two towel clamps around the isolated rib approximately five to six centimetres apart from one another. The cranial clamp should be positioned at the end of the twelfth rib approximately several centimetres caudal to the xiphoid. Elevation of this rib by the towel clamps helps stabilize the rib and retracts it away from the diaphragm. Directly incise over the twelfth rib with a scalpel blade between the towel clamps. The transversus abdominalis muscle will separate, exposing the cartilaginous rib. This incision can be done safely since the rib prevents accidental blade damage to surrounding structures. After the incision is completed, remove the towel clamps. [...]