Laparoscopic-assisted Gastropexy Research Articles

Köpeklerde Proflaktik Gastropeksi Tekniklerin Gastrin Hormonu ve Pankreas Enzim Seviyelerine Etkisinin Araştırılması

Gastrik dilatasyon volvulus problemine predispoze ırk olan 15 köpeğe proflaktik amaçla endoskopik gastropeksi, laparoskopik gastropeksi ve ventral orta hat gastropeksi tekniklerini uygulayarak, iyileşme sürecinde mideden ve pankreastan salgılanan amilaz, lipaz ve gastrin seviyelerindeki değişiklikleri karşılaştırılarak tekniklerin avantaj ve dezavantajları araştırıldı.
 Çalışmada 15 köpek, orta ventral hat, laparoskopik ve endoskopik destekli gastropeksi için 3 gruba ayrıldı. Birinci gruptaki 5 köpekte klasik gastropeksi, İkinci gruptaki köpeklerde laparoskopik destekli gastropeksi ve üçüncü gruptaki köpeklerde ise endoskopik gastropeksi operasyonu uygulandı. Her gruptaki köpeğe preoperative, postoperative 1. gün ve 8. günde amilaz, lipaz ve gastrin ölçümleri yapılarak elde edilen veriler istatistiksel olarak değerlendirildi. Operasyon sonunda klinik olarak herhangi bir patolojiye rastlanılmadı. Elde edilen amilaz, lipaz ve gastrin seviyeleride normal standart referanslar aralığında bulundu.
 Sonuç olarak, enzim salınımları yönünden yapılan operasyon tekniklerinin birbirlerine istatistik açıdan bir üstünlükleri olmadığını destekler niteliktedir. Tekniklerin uygulama ve zaman olarak birbirlerine avantaj ve dezavantajları bulunsa dahi bu üç teknikten herhangi bir tanesinin amilaz, lipaz ve gastrin enzimlerinin enzimatik sonuçları yönünden istatistiki bir fark oluşturmayacağı, her üç tekniğin de profilaktik amaçla kullanılabileceği görüşü ağırlık kazanmıştır. Fakat post-operatif dönemin daha uzun tutulması ile enzimatik ve mide motilitesinde değişikliklerin olabileceği düşünülmektedir. Bu açıdan daha fazla olgu ile daha uzun post-operatif dönem değerlendirilmelidir.

Clinical and videofluoroscopic outcomes of laparoscopic treatment for sliding hiatal hernia and associated gastroesophageal reflux in brachycephalic dogs.

To describe a laparoscopic technique for treatment of sliding hiatal hernia (SHH) and associated gastroesophageal reflux (GER) in brachycephalic dogs and document clinical and videofluoroscopic outcomes postoperatively. Prospective clinical trial. Eighteen client-owned dogs. A three-port laparoscopic approach was used. Intracorporeal suturing was used for hiatal plication and esophagopexy, and left-sided laparoscopic or laparoscopic-assisted gastropexy was performed. A standardized canine dysphagia assessment tool (CDAT) questionnaire was completed by owners pre- and postoperatively. Videofluoroscopic swallow studies (VFSS) were used to evaluate esophageal function, and impedance planimetry was used to assess lower esophageal sphincter geometry preoperatively and in a subset of dogs postoperatively. Median age was 27.5 (range 5-84) months. Conversion to open surgery was necessary in 1 (5.5%) of 18 dogs. Regurgitation after eating, and associated with activity/exercise, improved significantly when comparing pre- and postoperative CDAT assessments. Hiatal hernia and GER severity scores improved significantly between pre- and postoperative VFSS assessments, whereas SHH and GER frequency scores did not. One dog developed pneumothorax intraoperatively, underwent cardiopulmonary arrest, and died. Minor complications included splenic (n=6) and hepatic lacerations (n=3) that did not require specific therapy. A laparoscopic approach to treatment of SHH and GER led to improvements in clinical and VFSS indices in the majority of brachycephalic dogs. However, a subset of dogs still demonstrated some clinical signs postoperatively. In experienced hands, laparoscopic treatment of SHH and GER offers a minimally invasive alternative to open surgery.

Outcomes and Complications in a Case Series of 39 Total Laparoscopic Prophylactic Gastropexies Using a Modified Technique

Simple SummaryGastric dilatation and volvulus is a very severe condition that is most commonly seen in large and giant deep-chested dogs, although any dog may be affected. Recently, an increasing number of breeders and owners have become aware of the benefits of prophylactic gastropexy. Many techniques have been developed to perform gastropexy, but laparoscopic surgery, having very low levels of morbidity and invasiveness, fits well with the concept of prevention. The aim of this study is to validate a rapid, modified total laparoscopic prophylactic gastropexy technique with a low rate of complications. The results show that this procedure is safe and effective. Using this technique, it is possible to respect animal welfare and prevent the development of a life-threatening syndrome.Laparoscopic-assisted, laparoscopic, and endoscopic gastropexy techniques have been proven successful in recent years. Thanks to minimal invasiveness, low morbidity, and fast recovery, total laparoscopic gastropexy techniques have been gaining popularity. The objective of this study was to describe the use of a modified minimally invasive technique to perform prophylactic gastropexy in dogs. A case series study of 39 client-owned dogs was undertaken from June 2019 to August 2020. Each dog underwent total laparoscopic prophylactic gastropexy using a simple continuous barbed suture line and two laparoscopic needle holders without incising the seromuscular layer of the stomach and the abdominal wall. Surgical time, the number of stitches, and the length of suture were recorded. Telephone checks, owner questionnaires, and ultrasonographic exams were used to evaluate the effectiveness of the procedure after surgery. The median gastropexy surgical time was 12 min (range 4–30 min), and the median length of the suture line was 3 cm (range 2–4 cm). The last follow-up check was carried out 9 months (mean, range 3–14 months) after surgery, and all ultrasonographic exams (n = 29) showed an intact gastropexy. Intraoperative and postoperative complications were noted. This total laparoscopic gastropexy technique was found to be safe, fast, simple, and with a low morbidity rate. It appears to be a new alternative to other methods of prophylactic gastropexy; however, further research in this area is warranted.

Long‐Term Outcome and Complications Following Prophylactic Laparoscopic‐Assisted Gastropexy in Dogs

To characterize the short- and long-term outcome (>12 months), complications, and owner satisfaction following prophylactic laparoscopic-assisted gastropexy (LAG) in dogs. Retrospective study. Client-owned dogs (n = 49). Dogs that underwent prophylactic LAG at 2 veterinary academic hospitals were studied. Surgical time, anesthesia time, concurrent intra- and extra-abdominal procedures, and intraoperative and postoperative complications were recorded following review of medical records. Veterinarian and/or owner follow-up was obtained to determine outcome and satisfaction with LAG. Five of 49 dogs (10%) experienced complications related to abdominal access during LAG. Four percent (2/49) of dogs experienced an intraoperative complication. Follow-up information was available for 89% of dogs (44/49). Four dogs died of causes unrelated to LAG or gastric dilatation volvulus (GDV) in the follow-up period. Two dogs experienced major postoperative complications requiring additional veterinary intervention. Thirty percent (13 dogs) experienced a minor postoperative self-limiting wound-related complication. Median follow-up time was 698 days (range, 411-1825). No dogs experienced GDV. One hundred percent of dog owners were satisfied with LAG, would repeat the procedure in a future pet, and would recommend the procedure to a friend or family member. LAG was an effective procedure for prevention of GDV and was associated with high client satisfaction in this cohort of dogs. A moderate rate of postoperative wound complications occurred that were minor and self-limiting in nature.

Elective gastropexy with a reusable single-incision laparoscopic surgery port in dogs: 14 cases (2012-2013).

OBJECTIVE To describe the technique, clinical findings, and short-term outcome in dogs undergoing laparoscopic-assisted incisional gastropexy with a reusable single-incision surgery port. DESIGN Retrospective case series. ANIMALS 14 client-owned dogs. PROCEDURES Medical records of dogs referred for elective laparoscopic gastropexy between June 2012 and August 2013 were reviewed. History, signalment, results of physical examination and preoperative laboratory testing, surgical procedure, duration of surgery, postoperative complications, duration of hospital stay, and short-term outcome were recorded. All patients underwent general anesthesia and were positioned in dorsal recumbency. After an initial limited laparoscopic exploration, single-incision laparoscopic-assisted gastropexy was performed extracorporeally in all dogs via a conical port placed in a right paramedian location. Concurrent procedures included laparoscopic ovariectomy (n = 4), gastric biopsy (2), and castration (7). Short-term outcome was evaluated. RESULTS Median duration of surgery was 76 minutes (range, 40 to 90 minutes). Intraoperative complications were minor and consisted of loss of pneumoperitoneum in 2 of 14 dogs. A postoperative surgical site infection occurred in 1 dog and resolved with standard treatment. Median duration of follow-up was 371 days (range, 2 weeks to 1.5 years). No dogs developed gastric dilation-volvulus during the follow-up period, and all owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that single-incision laparoscopic-assisted gastropexy with a reusable conical port was feasible and effective in appropriately selected cases. Investigation of the potential benefits of this reusable port versus single-use devices for elective gastropexy in dogs is warranted.

Gastric volvulus after laparoscopic fundoplication: a rare complication after Heller-Dor operation for achalasia

A laparoscopic Heller-Dor operation is a safe and effective procedure for esophageal achalasia. We experienced postoperative gastric volvulus after performing a laparoscopic Heller-Dor operation. This was successfully treated with laparoscopic-assisted gastropexy. A 56-year-old Japanese woman had complained of dysphagia for 3 years. She was diagnosed as having achalasia and then underwent a laparoscopic Heller-Dor operation. She complained of nausea and abdominal fullness on postoperative day 5 and gastrography revealed organoaxial gastric volvulus. We performed a reoperation using a laparoscopic-assisted approach. Because of preexisting gastric ptosis, the stomach was unusually movable. In addition, a rotational torque due to the fundoplication might have caused the volvulus. We performed an anterior gastropexy. The patient’s dysphagia disappeared after the second surgery, and recurrent volvulus has not been observed for 13 months. In cases with an unusually movable stomach, the addition of gastropexy may be effective in preventing postoperative gastric volvulus, which is rare but may possibly occur after laparoscopic fundoplication.

Evaluation of short- and long-term complications after endoscopically assisted gastropexy in dogs

To determine short- and long-term complications in clinically normal dogs after endoscopically assisted gastropexy. Prospective case series. 24 dogs. Endoscopically assisted gastropexy was performed on each dog. Dogs were evaluated laparoscopically at 1 or 6 months after surgery to assess integrity of the gastropexy. Long-term outcome was determined via telephone conversations conducted with owners > or = 1 year after surgery. Mean +/- SD gastropexy length was 4.5 +/- 0.9 cm, and mean duration of surgery was 22 +/- 5 minutes. One dog had a partially rotated stomach at the time of insufflation, which was corrected by untwisting the stomach with Babcock forceps. Two dogs vomited within 4 weeks after surgery, but the vomiting resolved in both dogs. Four dogs had diarrhea within 4 weeks after surgery, which resolved without medical intervention. In all dogs, the gastropexy site was firmly adhered to the abdominal wall at the level of the pyloric antrum. Long-term follow-up information was available for 23 dogs, none of which had any episodes of gastric dilatation-volvulus a mean of 1.4 years after gastropexy. Endoscopically assisted gastropexy can be a simple, fast, safe, and reliable method for performing prophylactic gastropexy in dogs. At 1 and 6 months after gastropexy, adequate placement and adhesion of the gastropexy site to the body wall was confirmed. Such a procedure could maximize the benefits of minimally invasive surgery, such as decreases in morbidity rate and anesthetic time. This technique appeared to be suitable as an alternative to laparoscopic-assisted gastropexy.

Prospective Evaluation of Two Intracorporeally Sutured Prophylactic Laparoscopic Gastropexy Techniques Compared with Laparoscopic‐Assisted Gastropexy in Dogs

To report technique, surgical time, complication rate, and postoperative activity in dogs undergoing 2 intracorporeally-sutured total laparoscopic gastropexy (TLG) techniques compared with a laparoscopic-assisted gastropexy (LAG) technique. Randomized clinical trial. Dogs (n=30) weighing >25 kg. Dogs were randomly assigned to 1 of 3 groups. Two TLG techniques were performed using a median 3 portal technique. One of 2 suturing techniques was used to approximate corresponding incisions made in the stomach and body wall; using intracorporeal hand-suturing or a suture-assist device (Endostitch). In a 3rd group, a previously reported LAG technique was used. All dogs had an activity monitor placed for 7 days pre- and postoperatively. Linear regression analyses were performed to evaluate the association of surgical procedure on gastropexy time and the percentage change in activity counts. Median gastropexy time was 28 minutes (range, 20-41 minutes) for LAG, 48 minutes (range, 39-61 minutes) for the hand suture TLG technique, and 56 minutes (range, 30-90 minutes) for the Endostitch TLG technique. LAG was performed faster than TLG (P<.05). LAG dogs had a greater decrease in postoperative activity than TLG dogs (P=.005); however there was no difference in surgical time or postoperative activity between TLG techniques. TLG can be performed safely and effectively in dogs and although it takes longer, it has less impact on postoperative activity compared with LAG. TLG techniques may have advantages over LAG as measured by a greater willingness of dogs to move around postoperatively.

A rapid and strong laparoscopic-assisted gastropexy in dogs.

To develop a technique for laparoscopic gastropexy in dogs and evaluate effects on stomach position and strength of the adhesion between the stomach and abdominal wall. 8 healthy dogs. Dogs were anesthetized, and the abdomen was insufflated with carbon dioxide. A laparoscope was placed through a cannula inserted on the abdominal midline caudal to the umbilicus. Babcock forceps placed through a cannula inserted lateral to the right margin of the rectus abdominus muscle were used to exteriorize the pyloric antrum, a longitudinal incision was made through the serosa and muscular layer of the pyloric antrum, and the seromuscular layer of the pyloric antrum was sutured to the transversus abdominus muscle. After surgery, positive-contrast gastrography was used to evaluate stomach position and the onset of gastric emptying, and ultrasonography was used to assess stomach wall activity and mobility. Dogs were euthanatized 1 month after surgery, and tensile strength of the adhesion was tested. In all dogs, stomach position and the onset of gastric emptying were normal 25 days after surgery, and the pyloric antrum was firmly attached to the abdominal wall 30 days after surgery. Mean +/- SD ultimate load of the adhesion in tension was 106.5 +/- 45.6 N. The laparoscopic gastropexy technique described in the present study could be performed quickly and easily by an experienced surgeon, resulted in a strong fibrous adhesion between the stomach and abdominal wall, and appeared to cause minimal stress to the dogs.

An easy method for laparoscopic-assisted percutaneous anterior gastropexy.

Laparoscopic antireflux surgery is becoming a standard procedure in pediatric surgery. Anterior gastropexy is often performed in antireflux procedures, as well as in children with recurrent and intermittent volvulus of the stomach. We present a simple and secure technique for anterior laparoscopic-assisted gastropexy.