Effect of Laparoscopic-assisted Gastropexy on Gastrointestinal Transit Time in Dogs

Learning Curve in Two-Port Laparoscopic Gastropexy Using FlexDex

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CLINICAL SIGNIFICANCE

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.

SmartPill™ Administration to Assess Gastrointestinal Function after Spinal Cord Injury in a Porcine Model-A Preliminary Study

Gastrointestinal (GI) complications, including motility disorders, metabolic deficiencies, and changes in gut microbiota following spinal cord injury (SCI), are associated with poor outcomes. After SCI, the autonomic nervous system becomes unbalanced below the level of injury and can lead to severe GI dysfunction. The SmartPill™ is a non-invasive capsule that, when ingested, transmits pH, temperature, and pressure readings that can be used to assess effects in GI function post-injury. Our minipig model allows us to assess these post-injury changes to optimize interventions and ultimately improve GI function. The aim of this study was to compare pre-injury to post-injury transit times, pH, and pressures in sections of GI tract by utilizing the SmartPill™ in three pigs after SCI at 2 and 6 weeks. Tributyrin was administered to two pigs to assess the influences on their gut microenvironment. We observed prolonged GET (Gastric Emptying Time) and CTT (Colon Transit Time), decreases in contraction frequencies (Con freq) in the antrum of the stomach, colon, and decreases in duodenal pressures post-injury. We noted increases in Sum amp generated at 2 weeks post-injury in the colon, with corresponding decreases in Con freq. We found transient changes in pH in the colon and small intestine at 2 weeks post-injury, with minimal effect on stomach pH post-injury. Prolonged GETs and CTTs can influence the absorptive profile in the gut and contribute to pathology development. This is the first pilot study to administer the SmartPill™ in minipigs in the context of SCI. Further investigations will elucidate these trends and characterize post-SCI GI function.

From Chihuahua to Saint-Bernard: how did digestion and microbiota evolve with dog sizes

Health and well-being of dogs are of paramount importance to their owners. Digestion plays a key role in dog health, involving physicochemical, mechanical and microbial actors. However, decades of breeding selection led to various dog sizes associated with different digestive physiology and disease sensitivity. Developing new products requires the consideration of all the multi-faceted aspects of canine digestion, the evaluation of food digestibility, drug release and absorption in the gut. This review paper provides an exhaustive literature survey on canine digestive physiology, focusing on size effect on anatomy and digestive parameters, with graphical representation of data classified as "small", "medium" and "large" dogs. Despite the huge variability between protocols and animals, interesting size effects on gastrointestinal physiology were highlighted, mainly related to the colonic compartment. Colonic measurements, transit time permeability, fibre degradation, faecal short-chain fatty acid concentration and faecal water content increase while faecal bile acid concentration decreases with body size. A negative correlation between body weight and Proteobacteria relative abundance was observed suggesting an effect of dog body size on faecal microbiota. This paper gathers helpful in vivo data for academics and industrials and supports the development of new food and pharma products to move towards canine personalized nutrition and health.

Prevalence of gastrointestinal lesions in dogs chronically treated with nonsteroidal anti-inflammatory drugs

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common pharmaceutical associated with gastroduodenal ulceration and perforation. The prevalence of gastrointestinal (GI) injury associated with chronic use of NSAIDs in dogs is unknown.

OBJECTIVE/HYPOTHESIS

To determine the prevalence of GI mucosal erosions in dogs receiving chronic treatment with NSAIDs. We hypothesized that dogs receiving NSAIDs would have more GI mucosal erosions and longer GI transit time than a control population.

ANIMALS

Fourteen client-owned medium- and large-breed dogs receiving an NSAID for at least 30 days and 11 client-owned control dogs undergoing video capsule endoscopy (VCE) for evaluation of chronic GI disease.

METHODS

Dogs were prospectively recruited after determining no clinically relevant comorbidities were present and VCE was performed. The GI transit time and the presence of mucosal lesions were recorded.

RESULTS

Twelve dogs receiving NSAIDs and 11 retrospectively evaluated control dogs were included. The NSAIDs administered included carprofen (9 dogs), meloxicam (2 dogs), and firocoxib (1 dog) for a median of 6 months. Ten (83.3%; 95% confidence interval; 51.6%-97.9%) NSAID-treated dogs had GI erosions. Erosions were seen with all 3 NSAIDs in at least 1 dog. Three of 11 control dogs had gastric erosions. Dogs receiving NSAIDs had more erosions detected (P = .004).

CONCLUSIONS AND CLINICAL RELEVANCE

Subclinical GI erosions are more common in dogs receiving chronic treatment with NSAIDs than in control dogs with chronic GI disease, suggesting that NSAIDs be used with caution, particularly in dogs with comorbidities predisposing them to GI ulceration.

Comparison of total laparoscopic gastropexy with the Ethicon Securestrap fixation device versus knotless barbed suture in dogs

BACKGROUND

This study evaluated the feasibility and efficacy of a laparoscopic absorbable fixation device (Securestrap) in total laparoscopic gastropexy in dogs susceptible to gastric dilatation-volvulus (GDV) compared to laparoscopic gastropexy performed with a barbed suture. We hypothesised that both techniques provide suitable gastropexy.

METHODS

The gastropexy was performed by straps (TLG-SS group, n = 6) or with a barbed suture (TLG-Vloc group, n = 6). The total surgery time, gastropexy time, the number of straps used and suture bites were recorded. Clinical and ultrasound investigations were performed during follow-up.

RESULTS

The total surgery time was 30 minutes in the TLG-SS, while it was 46.66 minutes in the TLG-Vloc. In the TLG-SS group, gastropexy time was 13 minutes, while 36.3 minutes in the TLG-Vloc. The number of straps employed in TLG-SS was 9, while seven bites were employed in TLG-Vloc. Linear regression analysis of gastropexy time versus the number of procedures was highly correlated (r² = 0.84) in the TLG-SS. Complications, clinical and ultrasound findings did not differ between the two techniques at 90 days post-surgery.

CONCLUSION

TLG-SS laparoscopic technique can be employed safely and effectively in less time and is associated with a relatively short learning curve, which could encourage the widespread use of prophylactic laparoscopic gastropexy.

Absorbable fixation straps for laparoscopic gastropexy in dogs

OBJECTIVE

To evaluate the feasibility and efficacy of laparoscopic absorbable fixation straps (AFS) for laparoscopic gastropexy in dogs.

STUDY DESIGN

Cadaveric and prospective clinical study.

ANIMALS

Five dog cadavers for the cadaveric study; 12 dogs for the clinical study.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

CLINICAL SIGNIFICANCE

This novel laparoscopic technique can be employed safely, effectively, and reasonably quickly, and the learning curve is expected to be relatively short.

A pilot study on the effect of fat loading on the gastrointestinal tract of healthy dogs

OBJECTIVE

To assess the effect of a high fat meal (fat loading) on gastrointestinal motility and the appearance of intestinal villi using video capsule endoscopy and ultrasound.

MATERIALS AND METHODS

Four healthy staff-owned dogs were included in a prospective blinded crossover study. Dogs had initial baseline video capsule endoscopy to measure gastrointestinal transit times and allow for visual assessment of intestinal mucosa. Abdominal ultrasound was also performed to obtain intestinal wall measurements and assess for the presence of mucosal hyperechoic speckling. All dogs had diagnostics repeated twice between one and two hours after ingestion of either corn oil or dairy cream for a total of four control and 16 fat loaded studies.

RESULTS

Dogs in the corn oil group had greater mean gastric emptying times (740.3 ± 187.6 minutes vs. 237.9 ± 155 minutes) and total transit times (54.50 ± 22.2 hours vs. 23.25 ± 6.1 hours) than controls. Feeding of a fatty meal resulted in substantial retention of the capsules (10 of 16) within the stomach. While intestinal wall thickness of fat loaded dogs did not differ from control dogs, mucosal hyperechoic speckling scores of the duodenum of dairy cream dogs were greater when compared to control dogs (1.625 ± 0.518 vs. 0.500 ± 0.577).

CLINICAL SIGNIFICANCE

Data from this pilot study provides further evidence that feeding of a small high fat meal results in ultrasonographic as well as visual changes to the intestinal mucosa of healthy dogs. This data suggests that previous recommendations to feed fatty meals to dogs with lymphangiectasia might not allow differentiation with healthy individuals. In addition, due to the marked effect on gastric emptying time, video capsule endoscopy should be avoided in dogs fed a high fat meal.

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

OBJECTIVE

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.

SAMPLE

30 stomach and abdominal body wall specimens.

PROCEDURES

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.

RESULTS

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).

CONCLUSIONS AND CLINICAL RELEVANCE

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.

Evaluation of gastric motility in nine dogs before and after prophylactic laparoscopic gastropexy: a pilot study

BACKGROUND

The purpose of this study was to evaluate the effect of a prophylactic laparoscopic gastropexy on gastric motility in healthy large-breed dogs.

METHODS

This was a prospective pilot study with nine healthy client-owned dogs. Each dog was its own control. Gastric motility was evaluated before and after laparoscopic gastropexy. Dogs were fed a standard diet three weeks before and after surgery. Gastric motility was measured before and 3 weeks after surgery. A wireless motility capsule (WMC) was used to measure gastric pH, intragastric pressure, temperature, frequency of contractions, motility index (MI) and transit time. Non-parametric statistical analysis was used to compare the paired data. Clients were contacted for follow-up information 2 years postoperatively.

RESULTS

Median frequency of gastric contractions was 1.3 (range, 0.6-1.9 contractions/min) before gastropexy and 1.0 (range, 0.3-2.6 contractions/min) after gastropexy (P = 0.820). Median MI was 49.2 (range, 23.7-96.6) before gastropexy and 28.1 (range, 12.2-148.9) after gastropexy (P = 0.652). Median gastric emptying time was 1140 (range, 486-1230 min) before gastropexy and 1110 (range, 306-2610 min) after gastropexy (P = 0.570). During the hour before the WMC passed through the pylorus, median MI was 72.2 (range, 48.2-549.3) before gastropexy and 52.9 (range, 15.20-322.8) after gastropexy (P = 0.734), and frequency of contractions was 1.1 (range, 0.9-4.1 contractions/min) before gastropexy and 1.2 (range, 0.5-3.0 contractions/min) after gastropexy (P = 0.652).

CONCLUSION

Motility in the stomach did not change in healthy dogs after prophylactic laparoscopic gastropexy. We conclude that preventive laparoscopic gastropexy does not induce gastroparesis.

Simplified Minimally Invasive Surgical Approach for Prophylactic Laparoscopic Gastropexy in 21 Cases

The objective of this study was to describe the operative technique and outcome of a simplified laparoscopic gastropexy approach in dogs. Twenty-one dogs undergoing prophylactic laparoscopic gastropexy with a simple continuous barbed suture without incising the seromuscular layer of the stomach and transversus abdominis muscle were reviewed. In 20 cases, additional procedures were performed (18 ovariectomies and 2 prescrotal castrations); 1 dog had two prior episodes of gastric dilation without volvulus and underwent gastropexy with a prophylactic intent. The gastropexy procedure had a median duration of 33 min (range 19-43 min). V-Loc 180 absorbable and the V-Loc PBT nonabsorbable suturing devices were used in 8 and 13 dogs, respectively. Minor intraoperative complications occurred in four cases: broken suture (1), needle dislodgement (2), and folded needle (1). Minor complications included self-limiting wound complications (3), abdominal discomfort (2), vomiting (1), and inappetence (2). Postoperative abdominal ultrasound performed after a median of 8 mo (6-36 mo) confirmed permanent adhesion at the gastropexy site in all dogs. One dog developed a fistula (1 yr postoperatively) and another a granuloma (3 mo postoperatively), both at the gastropexy site. Prophylactic laparoscopic gastropexy may be performed with knotless unidirectional barbed suture without creating an incision on the abdominal wall and stomach.

Gastrointestinal effects following acupuncture at Pericardium-6 and Stomach-36 in healthy dogs: a pilot study

OBJECTIVES

To quantify changes in gastric and intestinal emptying times in the conscious dog following gastrointestinal acupoint stimulation.

MATERIALS AND METHODS

In a randomised, blinded crossover study, six dogs were fed 30×1.5 mm barium-impregnated polyethylene spheres and underwent: (1) no acupuncture (Control); (2) stimulation of target points PC6 and ST36 (Target) and (3) stimulation of non-target points LU7 and BL55 (Sham). Abdominal radiographs were assessed immediately after feeding the spheres and every hour for 12 hours and their number in the stomach and large intestines was counted.

RESULTS

The number of barium-impregnated polyethylene spheres found distal to the stomach was less in the Target group compared to the Control and Sham groups between hours 2 and 4, but no differences between groups were seen for the remainder of the treatment period. The number of spheres found within the colon/rectum was less in the Target group compared to the Control and Sham groups between hours 4 and 6, and compared to the Sham group only at hour 7 but no differences between groups were seen after hour 8.

CLINICAL SIGNIFICANCE

Acupuncture targeted at the gastrointestinal tract of dogs was associated briefly with slowed gastric emptying and gastrointestinal transit time. This foundational study lays the groundwork for additional studies of acupuncture effects associated with altered physiologic states.