Laparoscopic Gastropexy Research Articles

BN SO16 - Gastro-gastric intussusception without any lead point – a case report and review of literature

Abstract Background Gastrogastric intussusception in a rare condition in adults. The underlying aetiologies include pathological lead points, anatomical abnormalities, previous foregut surgery or foreign body. The management of symptomatic gastrogastric intussusception in the absence of these aetiologies remains poorly defined and is highlighted by the paucity of evidence available for guidance. We present a case of idiopathic gastrogastric intussusception and a review of the literature. Method A 34-year-old male patient with a background of thrombocytopenia-absent radius (TAR) syndrome presented with recurrent episodes of upper abdominal pain and vomiting. Investigations with a CT abdomen revealed proximal gastrogastric intussusception. Subsequent endoscopy showed oedematous mucosa along the lesser curve and no pathological lead points or anatomical abnormalities. Histological findings were normal. Results The patient remained symptomatic despite a normal subsequent CT abdomen. A consensus decision was reached, and the patient was counselled for a laparoscopic gastropexy. Laparoscopic findings showed a central area of scar tissue circumferentially along the mid-body of the stomach highlighting the chronicity of the condition. No hiatal abnormalities were identified. A gastropexy was performed in two layers along the greater curvature of the stomach with non-absorbable interrupted sutures. The postoperative course was unremarkable. The patient remained asymptomatic on 6-week clinic follow up. Conclusion No previous case reports of idiopathic gastrogastric intussusception were identified on our literature search. It is our impression that this is the first such case-report to illustrate the diagnostic challenges of this rare, intermittently symptomatic condition and the successful management of it.

Gastric volvulus in children: diagnosis and treatment approaches

Gastric volvulus is a sporadic disease in the pediatric age group and is very complex in terms of etiology and management. In this study, we aimed to discuss two late-diagnosed gastric volvulus cases, review the diagnosis and treatment methods of gastric volvulus cases in the pediatric age group encountered in the literature, and reduce concerns about the correct diagnostic approach to these cases. The first case was an 8-year-old girl who was followed up due to developmental delay and metabolic disease and was admitted due to recurrent vomiting attacks. The endoscopic reduction was first performed on the patient whose upper gastrointestinal tract imaging was compatible with organoaxial gastric volvulus. Since vomiting attacks continued, laparoscopic gastropexy was performed. In the postoperative follow-up, there was weight gain and vomiting complaints wholly regressed. The second case was a 1-year-old girl who was treated for gastroesophageal reflux at an external center due to vomiting and developmental delay, but she did not receive any response. The endoscopic reduction was performed because the patient's upper gastrointestinal imaging was compatible with the organoaxial gastric volvulus. Laparoscopic gastropexy was performed on the patient whose vomiting recurred. The stomach was expected to be seen in the upper passage imaging in the postoperative period. In the systematic search made in the MEDLINE/Pubmed database using the keywords "gastric volvulus and pediatric," 41 literature articles presenting 47 cases between 2013 and 2023 were included. The patient's age, gender, complaints at admission, type of gastric volvulus, and treatment-related data were collected. The most common symptoms in the patients were vomiting, and abdominal pain and the most common comorbidities were diaphragmatic pathologies and wandering spleen. The most preferred treatment was anterior gastropexy. Gastric volvulus is characterized by vomiting, abdominal pain, and developmental delay. It is tough to diagnose, especially in chronic cases. In addition to the conservative approach in chronic cases, anterior gastropexy should be preferred to prevent recurrent volvulus attacks.

Learning Curve in Two-Port Laparoscopic Gastropexy Using FlexDex.

Keyhole gastropexy is becoming increasingly popular, and the new development facilitates shorter surgical times. This paper reports on the learning curve in two-port laparoscopic gastropexy using FlexDex in a specialist's hands. FlexDex is a novel tool combining aspects of robotic surgery without requiring an expensive robot theatre setting. Cohort of 16 dogs >25 kg and at high risk of gastric volvulus and dilatation (GDV) undergoing elective laparoscopic gastropexy were enrolled in the study consecutively from 5/2022 to 9/2023. All patients were operated on by one surgeon (FM), and surgical time was recorded to assess learning curve. Competence was defined as plateauing surgical time. Detailed follow-up at 1 day, 7 days, 14 days, 2 months, 6 months, and long-term was recorded for success rate and complications. Ultrasound examination was scheduled at 4-6-month review to confirm lasting success of the gastropexy. All 16 patients were operated on successfully without any significant complications, as confirmed on the ultrasound. The surgical time of laparoscopic gastropexy reduced from 52 to 14 min (reduction of 38 min/73%) and reached plateau after the 12th case of the 16, making it a very steep learning curve in specialist hands. There were no serious complications, and success rate was 100% at the 6-month ultrasound assessment. This is the first paper to report on the learning curve with the FlexDex device in a two-port laparoscopic gastropexy setting. It effectively halves the operating time to 30 min, making the surgery safer for the patient and more cost-efficient, without compromising the result.

Association of mesenteric volvulus in police working dogs with and without a prior prophylactic laparoscopic gastropexy.

To evaluate the association of mesenteric volvulus (MV) in New York Police Department police working dogs (PWDs) with and without a prior prophylactic laparoscopic gastropexy (PLG). 370 PWDs (82 with and 288 without PLG). Medical records and surgery and radiology reports were reviewed from 2012 to 2022. Signalment, pertinent history (medical and surgical), gastropexy status, temperament, and training type were recorded. Statistical analysis was used to identify the relationship between prophylactic gastropexy and MV within the patient population. 3 cases of mesenteric volvulus were noted in this patient population. Two (2.4%) of the 82 PWDs that had undergone prophylactic laparoscopic gastropexy developed MV, whereas 1 (0.3%) of the 288 PWDs that had not undergone a gastropexy procedure developed MV. Police working dogs with PLG were estimated to be at 7.2 times greater odds of MV (point estimate OR, 7.18; 95% CI, 0.642 to 80.143); however, the low incidence of MV in this population limited statistical power, and thus this effect did not achieve statistical significance. Evaluation of MV incidence in additional populations of working dogs will allow greater precision in the point estimate. Prophylactic gastropexy may be associated with an increased risk for MV. However, patients without prophylactic gastropexy are at risk for gastric dilatation and volvulus, which is more common than MV. Therefore, the authors continue to recommend prophylactic gastropexy to decrease the risk for gastric dilatation and volvulus.

Effect of preoperative ondansetron on postoperative nausea in healthy dogs undergoing laparoscopic gastropexy and castration

ObjectiveTo investigate if preoperative ondansetron reduces postoperative nausea associated with laparoscopic gastropexy and castration in dogs. Study designProspective clinical study. AnimalsTwenty client-owned, healthy male dogs. MethodsDogs were premedicated with dexmedetomidine (2–5 mcg kg–1) and methadone (0.2–0.5 mg kg–1) intramuscularly. General anesthesia was induced with propofol and maintained with an inhalant anesthetic agent. Dogs were randomized into group S (saline 0.1 mL kg–1, intravenously) or group O (ondansetron 0.2 mg kg–1, intravenously). Plasma and serum were collected before premedication and 3 hours postextubation to measure arginine vasopressin (AVP) and cortisol concentrations. Nausea scoring occurred before and 10 minutes after premedication, immediately after extubation, and at 1, 2 and 3 hours postextubation. Data were analyzed by mixed and split-plot anova with Bonferroni adjustment for the number of group comparisons. Significance was set at p < 0.05. ResultsNausea scores increased over time at 1 (p = 0.01) and 2 (p < 0.001) hours postextubation in both groups compared with before premedication. Median nausea score (0–100 mm) for groups S and O before premedication were 2.5 and 0.5 mm, respectively. At 1 and 2 hours postextubation, group S scored 7.5 and 4.0 mm and group O scored 6.0 and 5.0 mm, respectively. No significant differences in nausea scores within or between groups were observed before premedication and 3 hours postextubation. Cortisol concentrations increased significantly 3 hours postextubation in both groups (p < 0.001) compared with before premedication, with no differences between groups. AVP concentrations showed no significant differences within or between groups. Conclusions and clinical relevancePreoperative intravenous administration of ondansetron (0.2 mg kg–1) did not impact postoperative nausea after laparoscopic gastropexy and castration. Investigation of higher doses of ondansetron on the incidence of postoperative nausea and vomiting in dogs after surgery is warranted.

Mesentero-axial gastric volvulus treated with laparoscopic gastropexy: a case report

BackgroundMesentero-axial gastric volvulus (MAGV) is an uncommon subtype of gastric volvulus (GV). However, reports of such cases in adult patients are very rare. We present an unusual case of idiopathic MAGV in an old woman.Case presentationAn 84-year-old woman was referred to the emergency department for vomiting and abdominal pain. An abdominal computed tomography scan revealed a mesentero-axial gastric volvulus, which could be corrected endoscopically, and the symptoms were relieved. Contrast-enhanced examination was performed before the elective surgery to confirm the presence of short-axis dorsal 180-degree volvulus. The patient underwent laparoscopic surgery on a wait-and-watch basis. After releasing the torsion, the stomach returned to normal position. The gastric fornix was sutured to the left diaphragm and the gastric body and antrum were sutured to the abdominal wall using non-absorbable thread. Symptoms did not flare after the surgery.ConclusionsWe experienced a rare case of adult MAGV presenting with incomplete obstruction. Laparoscopic gastropexy is useful when gastric decompression is achieved.

Is pneumothorax secondary to pneumoperitoneum a real risk in dogs undergoing total laparoscopic gastropexy?

There were described in veterinary literature, the possibility of pneumothorax as a complication of laparoscopic surgery in dogs undergoing laparoscopic ovariectomy associated with total laparoscopic gastropexy. To assess if spontaneous pneumothorax secondary to pneumoperitoneum is a real risk in dogs undergoing total laparoscopic gastropexy. Dogs undergoing totally laparoscopic gastropexy received chest X-rays (CXR) in lateral (left and right) and ventro-dorsal projection before and after the surgery. Two veterinary radiologists reported the x-rays and indicated the presence or not of pneumothorax. Postoperative pneumothorax was not detected on postoperative CXR in the total of 76 dogs of the study. The odds risk of pneumothorax after total laparoscopic gastropexy surgical procedure is low.

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.&#x0D; 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.&#x0D; 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.

LBODP086 An Unusual Infant Case Of Gastric Volvulus Presenting With Dumping Syndrome

Abstract An 18-day female infant, born preterm small for gestational age (SGA), developed fasting hypoglycemia. A critical sample revealed an insulin level of 4.7 μIU/mL at the time of hyloglycemia (39 mg/dL) without ketoacidosis. Diazoxide therapy was started under the impression of transient neonatal hyperinsulinemia related to SGA, however, hypogycemia was developed on the 21st day of life. Targeted next generation sequencing (NGS) was performed for possible congenital hyperinuslinism. During octreotide therapy, postprandial hyperglycemia was incidentally detected at 27 days. Continuous glucose monitoring (CGM; Dexcom G6, San Diego, California) revealed postprandial hyperglycemia and subsequent hypoglycemia suggestive of dumping syndrome, although she had no prior history of surgery. An upper gastrointestinal series revealed the anomalous rotation of the stomach along the mesenteroaxial axis perpendicular to its longitudinal axis, implying gastric volvulus. The possibility of dumping syndrome caused by gastric volvulus was confirmed by stable glucose level in the euglucemic range using CGM after continuous nasojejunal feeding. She received laparoscopic gastropexy to anchor the stomach. Euglycemia was maintained after surgery and octreotide therapy was successfully discontinued. NGS identified no pathogenic variant for congenital hyperinsulinism. At 8 months of age, she exhibited catch-up growth and normal development. This is the first infant case of gastric volvulus presenting with dumping syndrome during diazoxide therapy for transient neonatal hyperinsulinism. Presentation: No date and time listed

Development and validation of a composed canine simulator for advanced veterinary laparoscopic training.

The development of innovative simulation models for veterinary laparoscopic surgery training is a priority today. This study aimed to describe a didactic simulation tool for the training of total laparoscopic gastropexy (TLG) with intracorporeal sutures in dogs. CALMA Veterinary Lap-trainer composite simulator (CLVTS) was developed from a plaster cast of 2 Great Dane canines mimicking the space and the correct position to carry out a TLG. After video instruction, 16 veterinarians with different degrees of experience in minimally invasive surgery (Experts, n = 6 and intermediates, n = 10) evaluated four sequential simulating TLG with intracorporeal suturing in the CLVTS. Subsequently, they completed an anonymous questionnaire analyzing the realism, usefulness, and educational quality of the simulator. The CLVTS showed a good preliminary acceptance (4.7/5) in terms of the usefulness and adequacy of the exercises that, in the participants' opinion, are appropriate and are related to the difficulty of the TLG. In addition, both experienced and intermediate surgeons gave high marks (4.5/5) to the feeling of realism, design, and practicality. There were no significant differences between the responses of the two groups. The results suggest that the CVLTS has both face and content validity. Where it can be practiced in a structured environment for the development of a total laparoscopic gastropexy with intracorporeal suture and without compromising patient safety, but still has some limitations of the scope of the study. Further studies are needed to establish the ability to assess or measure technical skills, including the degree of transferability to the actual surgical environment.

Post-colostomy internal hernia of the stomach treated with laparoscopic gastropexy: a case report

BackgroundInternal hernias are formed by the protrusion of internal organs through an aperture formed congenitally or postoperatively. Internal hernias are most commonly associated with the small intestine. Only two cases of a post-sigmoid colostomy internal hernia of the stomach have been reported. This hernia arises from the space between the lifted sigmoid colon and the left abdominal wall. In the two aforementioned cases, treatment comprised suturing of the sigmoid colon to the lateral abdominal wall and changing of the intraperitoneal route to an extraperitoneal one. Herein, we present a very rare case who underwent laparoscopic gastropexy for a post-sigmoid colostomy internal hernia of the stomach.Case presentationOur patient, a 67-year-old woman, was undergoing chemoradiation for rectal cancer and planned to undergo abdominoperineal resection. However, tumor perforation resulted in a high fever and a right gluteal abscess; therefore, a sigmoid colostomy was performed through the intraperitoneal route in the left lower abdomen. One month after the surgery, the patient presented to our emergency room with vomiting, abdominal pain, and abdominal distension. Computed tomography revealed a markedly distended stomach caused by the obstruction of the pylorus secondary to the colostomy; laparoscopic gastropexy was performed subsequently and the postoperative course was uneventful.ConclusionsThis is the first report on the laparoscopic gastropexy treatment of a post-sigmoid colostomy internal hernia of the stomach; our findings may help physicians manage such hernias.

Patients with gastric volvulus recurrence have high incidence of wandering spleen requiring laparoscopic gastropexy and splenopexy.

Though gastric volvulus in neonates and infants resolves by conservative therapy and aging, some cases require surgical intervention. This study aimed to review the cases of gastric volvulus requiring surgical intervention and evaluate their characteristics. We retrospectively reviewed gastric volvulus cases requiring surgical intervention. Surgical indication was persistent acute gastric volvulus and repeated hospitalization for gastric volvulus. We evaluated the characteristics of those cases requiring surgical intervention and the surgical results of laparoscopic gastropexy. The median age of patients included was 4years (range: 1-6years). All eight cases of gastric volvulus requiring sugery had congenital spleen diseases. Six of the eight cases suffered from a wandering spleen, while two cases presented with situs inversus with asplenia. Both splenopexy (preperitoneal distension balloon [PDB] or blunt separaion methods) and gastropexy were performed in cases with wandering spleen. No postoperative complications were reported in any of the eight cases, except the recurrence of gastric volvulus due to suture shedding in one case. Laparoscopic gastropexy for gastric volvulus and splenopexy for cases concomitant with wandering spleen were found to be effective surgical approaches. Both PDB and blunt separation methods for making extraperitoneal pockets for the spleen were employed successfully.

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.

Absorbable fixation straps for laparoscopic gastropexy in dogs.

To evaluate the feasibility and efficacy of laparoscopic absorbable fixation straps (AFS) for laparoscopic gastropexy in dogs. Cadaveric and prospective clinical study. Five dog cadavers for the cadaveric study; 12 dogs for the clinical study. 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. 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. 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. This novel laparoscopic technique can be employed safely, effectively, and reasonably quickly, and the learning curve is expected to be relatively short.

Biomechanical evaluation of an absorbable fixation strap for use in total laparoscopic gastropexy in dogs.

To compare load-to-failure results for laparoscopic absorbable fixation straps (AFSs) deployed at various angles and for AFSs versus absorbable knotless (barbed) suture when used in simulated total laparoscopic gastropexy (TLG) in specimens from cadaveric dogs. 30 stomach and abdominal body wall specimens. Specimens were assigned to 1 of 3 groups for use in simulated TLG constructs for comparisons of load-to-failure results for single AFSs deployed at 30°, 60°, or 90° (AFS-angle group; n = 10) or for a gastropexy span of 4 to 5 cm achieved with 3-0 absorbable knotless (barbed) monofilament suture applied in a simple continuous pattern (TLG-1; 10) versus 8 AFSs applied with a deployment angle > 30° (TLG-2; 10). A 1-way ANOVA was used to compare results among AFS deployment angles (30°, 60°, or 90°) and between TLG-1 and TLG-2. Mean ± SD load to failure for the AFS-angle group was significantly higher for the AFS deployment angles of 60° (8.00 ± 3.90 N) and 90° (12.71 ± 8.00 N), compared with 30° (5.17 ± 1.90 N). However, no substantial difference was detected in the mean ± SD load to failure for TLG-1 (39.18 ± 7.1 N) versus TLG-2 (31.43 ± 10.86 N). Results of the present study supported the potential use of AFSs in gastropexy in dogs; however, prospective clinical research with adequate long-term follow-up is warranted before recommendations can be made.

Outcomes after Laparoscopic Gastropexy as an Alternative for Paraesophageal Hernia Repair.

Background:Outcomes after laparoscopic gastropexy (LG), performed as an alternative to formal paraesophageal hernia (PEH) repair in patients with giant PEH, have been rarely studied. This manuscript evaluates complications and long-term quality-of-life after LG.Methods:An IRB-approved protocol was used to identify patients who underwent LG to alleviate symptoms of acute or chronic gastric obstruction secondary to a paraesophageal hernia. Postoperative outcomes and quality-of-life data were retrospectively collected via chart review and prospectively via phone interview.Results:Twenty-six patients underwent LG, with a median age of 76 (52 – 91). Median follow-up was 28 (3 to 55) months. Gastropexy was the chosen intervention due to comorbid conditions (23, 88%), gastric inflammation (2, 8%), or intraoperative instability (1, 4%). Nine (35%) suffered postoperative complications, and 2 (8%) required reoperation. At the time of follow-up, 7 (27%) had died, 3 (11%) could not be reached. Sixteen (62%) completed the follow-up survey. Fourteen (88%) reported symptom resolution. Ten (62%) still required antireflux medication. Median Gastroesophageal Reflux Disease-Health Related Quality of Life score was 4.5 (0 to 19). Fourteen (88%) denied current dietary restrictions. All reported satisfaction with the operation.Conclusion:Laparoscopic PEH repair remains the standard of care for the management of giant PEH. However, a subcategory of patients with high operative risk could be candidates for a shorter operative intervention. As our data infers, LG is a reasonable alternative in this patient population. While the continued use of antisecretory medications is sometimes required, LG restores the ability to tolerate full meals without restrictions and results in excellent patient satisfaction.

A Case of Gastric Volvulus with Hiatal Hernia Treated by Laparoscopic Gastropexy

A Case of Gastric Volvulus with Hiatal Hernia Treated by Laparoscopic Gastropexy

Intestinal surgery in small animals: historical foundations, current thinking, and future horizons.

Intestinal wounds require precise closure after intestinal biopsy, enterotomy, or enterectomy in small animals. Preexisting factors such as intra-abdominal sepsis and hypoalbuminemia as well as poor surgical technique increase the risk of intestinal dehiscence, with considerable negative impact on patient morbidity and mortality. Live dog studies have demonstrated the dangers of mucosal eversion especially in the septic abdomen. Approximating patterns preserve luminal diameter, heal optimally, and have equal bursting strength compared with inverting patterns after 24 hours. Simple interrupted and simple continuous suture patterns and disposable skin staples are established alternatives for manual wound closure. Knotless quilled suture currently used in laparoscopic gastropexy techniques shows bursting strength equal to monofilament sutures in dog cadaveric intestine. Dehiscence rates with hand sewn vs titanium automated stapling anastomosis are similar in uncomplicated cases; however, auto stapling devices may be the preferred method of anastomosis when preexisting abdominal sepsis is present and when patient size allows it. Regardless of the technique, current standard of care involves leak testing and omental wrapping, followed by early postoperative feeding. The past decade has ushered in an exciting new era of laparoscopic assisted techniques that have the potential to reduce postoperative pain and patient morbidity. An understanding of these applications will establish the future of minimally invasive small animal intestinal surgery for veterinary specialists. In summary, surgeons have a variety of methods at their disposal for optimal clinical outcome in small animal intestinal surgery.

Single-incision laparoscopic gastropexy for mesentero-axial gastric volvulus

BackgroundMesentero-axial gastric volvulus (MAGV) is a rare but critical condition as delay in treatment can lead to lethal situations. Although the report of the surgical treatment with laparoscopic approach for MAGV has recently come to be seen, no standard procedures have been established. We aim to describe our operative technique of single-incision laparoscopic gastropexy (SILG) for MAGV and review the relevant literature to ascertain the most appropriate treatment option in these patients.Case presentationThree patients were referred to our hospital because abdominal pain and vomiting suddenly occurred. Acute MAGV was diagnosed by upper gastrointestinal study. After overnight gastric decompression with a nasal tube, the GV was resolved spontaneously. Elective SILG was planned. Single incision at the umbilicus was made and three 5-mm trocars were inserted. The anterior wall of the body of the stomach was sutured to the peritoneum using 6 × 4-0 non-absorbable sutures for prevention of recurrence of GV and occurrence of internal hernia through the space created between the sutures. Two boys and a girl with mean age 4 ± 2 years underwent SILG. The mean time of the operation was 48 ± 23 min. All of the procedures were completed safely, and there were no postoperative complications. The mean time of postoperative hospitalization was 4 ± 1 days. All patients had good cosmetic and clinical results.ConclusionWe found SILG is a safe, technically feasible, and minimally invasive approach with low incidence of postoperative complication and the best cosmetic result for the patients with MAGV.

Comparison of laparoscopic gastropexy performed via intracorporeal suturing with knotless unidirectional barbed suture using a needle driver versus a roticulated endoscopic suturing device: 30 cases.

To compare two suturing techniques for prophylactic laparoscopic gastropexy in healthy dogs. Retrospective case series. Thirty healthy client-owned dogs from breeds predisposed to gastric dilation volvulus. Medical records of dogs presented for prophylactic laparoscopic gastropexy performed with knotless unidirectional barbed suture were reviewed. Dogs were grouped based on the device used for suturing, consisting of an endoscopic needle driver (END) vs an endoscopic suturing device (ESD). Signalment, weight, surgery time, number of suture bites per side of gastropexy, and intraoperative complications were compared between groups. The END group consisted of 10 dogs, with a median age of 1.09 years (range 0.5-2.67), weight of 41.5 kg (range 25-66), surgical time of 49.5 minutes (range 35-77), and a median of 5 suture bites per side (range 4-6). The ESD group included 20 dogs, with a median age of 1.75 years (range 0.6-8.75, P = .0944), weight was 37.5 kg (range 20-62, P = .5823), surgical time of 55 minutes (range 30-76, P = .808), and a median of 6 suture bites for the first side (range 4-7, P = .072) and 7 for the second side (range 4-8, P = .003). No major complications and no conversion to open celiotomy occured in either group. Minor complications occurred in 3 dogs in the ESD group, all related to device dysfunction and suture breakage. Laparoscopic gastropexy may be performed effectively with either of these suturing techniques.