Current evidence supporting simultaneous prophylactic gastropexy in canine patients undergoing complete splenectomy

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Appraisal, application and reflection

Gastric dilatation-volvulus (GDV) is a life-threatening condition in which the stomach dilates and rotates on its mesenteric axis. While this disease process is more commonly recognised in large- to giant-breed dogs, a study performed by Maki et al. (2017) revealed that GDV development is a documented post-surgical complication in some patients that have undergone a splenectomy.

It has been suggested in the veterinary literature that a prophylactic gastropexy should be considered in dogs that have undergone complete splenectomy to decrease the lifetime risk of GDV development, but the basis for this recommendation has been anecdotal. While there may be a perceived benefit to performing a gastropexy in any large- or giant-breed dogs undergoing a splenectomy, the current literature does not provide a true consensus. It may be that breeds predisposed to splenic torsion are also predisposed to development of GDV instead of a causative relationship between complete splenectomy and GDV development. Grange et al. (2012) discussed that a gastropexy is a relatively routine procedure that may help prevent GDV development, which is a life-threatening and quickly progressive disease, but could not find causation to perform a gastropexy in patients undergoing a previous complete splenectomy. Goldhammer et al. (2010) evaluated 33 dogs presenting for a non-elective gastropexy procedure due to GDV and noted that no study patients had a history of a previous splenectomy being performed. DeGroot et al. (2016) also found no statistical significance between GDV development in post-splenectomy patients (1/49 dogs) compared to patients that had not undergone a previous splenectomy (1/15 dogs). Hypotheses as to why there anecdotally may be an increased risk of GDV development secondary to complete splenectomy include increased laxity of gastric ligaments secondary to transection and increased intra-abdominal dead space, both of which allow for increased gastric mobility in the abdominal cavity.

DeGroot et al. (2016), a retrospective case series, could not draw meaningful conclusions regarding the importance of prophylactic gastropexy after complete splenectomy secondary to PST as there was no significant difference in the percentage of dogs with and without gastropexy that developed GDV. Goldhammer et al. (2010), Grange et al. (2012), and Maki et al. (2017), all of which were retrospective cohort studies with a cross-sectional survey component, drew similar conclusions to DeGroot et al. (2016) in that it was difficult to draw clinical conclusions based on results of their respective studies and further research was needed. Sartor et al. (2013), a retrospective case-control study, found results that conflicted with the previously mentioned studies. To the author’s knowledge, this is the only study truly documenting an increased odds of previous splenectomy having been performed in GDV patients, but it is difficult to draw meaningful clinical conclusions regarding the PICO question from these results as cases were compared to a general population of dogs that were presented to the veterinary hospital for a wide variety of ailments. In Sartor et al. (2013), they found that the odds of GDV in dogs with a history of previous splenectomy were significantly increased compared to those of dogs without a history of previous splenectomy, but the authors did not discuss whether any cases or controls had a gastropexy procedure previously and also did not discuss the aetiology of why a complete splenectomy was performed in the patients.

Grange et al. (2012) made an important point that while performing a prophylactic gastropexy is a relatively routine procedure, it is crucial to remember that the procedure is not without risk. Possible complications of prophylactic gastropexy, while rare, include anaesthetic complications, surgical failure with need for possible repair, changes in gastric motility, leakage of caustic stomach contents into the abdominal cavity secondary to full-thickness tissue penetration, and other complications related to increased surgery and anaesthesia time. It is essential to take into consideration individual patient factors when deciding if the benefit of an extra surgical procedure outweighs the risks. The documented complication rates for a gastropexy depends on the specific technique utilised with a recent shift towards a more minimally invasive procedure. Loy Son et al. (2016) evaluated complications following laparoscopic-assisted gastropexy in dogs. This study noted an intraoperative complication rate of 4-10% which included organ laceration, unsatisfactory suture location, and surgical access issues. A postoperative complication rate of 34% was found secondary to surgical site abnormalities (swelling, bruising, erythema, seroma formation, surgical site infection) with a majority of complications being minor and self-limiting.

Further research is needed in order to answer this PICO question. More ideal study designs include prospective cohort or case-control studies with follow-up information taken over the course of each dog’s lifetime, but ethical dilemmas may preclude these studies from progressing. Currently, there is no strong evidence that shows causation between complete splenectomy and GDV development, so it is difficult to draw clinical conclusions as to if a concurrent prophylactic gastropexy during and / or soon after complete splenectomy is of benefit to the general population of canine patients.

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