Use of real-time near-infrared fluorescence to assess gastric viability in dogs with gastric dilatation volvulus: A case-control study

OBJECTIVE

To describe near-infrared fluorescence (NIRF) for assessment of gastric viability and describe NIRF's influence on the surgeon's operative strategy in dogs with gastric dilatation and volvulus (GDV).

STUDY DESIGN

Prospective clinical trial.

ANIMALS

Twenty dogs with GDV and 20 systemically healthy dogs.

METHODS

Following gastric derotation, the surgeon's subjective assessment of gastric viability was recorded prior to near-infrared imaging. Changes in the surgeon's initial assessment of viability based on the visual pattern of gastric fluorescence was recorded. If nonviable (lack of defined vessels), a partial gastrectomy was performed and submitted for histopathology. The stapled gastrectomy line was imaged. Viable (defined vessels) and nonviable fluorescence intensities were compared with healthy dogs undergoing surgery for nongastrointestinal disease.

RESULTS

Subjective assessment diagnosed 17 viable and three nonviable GDVs (2 fundi; 1 cardia). Near-infrared imaging demonstrated nonviable gastric fluorescence in 4 dogs (3 fundi/cardia; 1 fundus). The surgeon's margins for resection were altered in 3/20 dogs. Fluorescence intensity (cardia, fundus, body, pylorus) was lower in GDV viable (30.59%, p = .04; 38.17%, p < .01; 51.18%, p < .01; 44.12%, p= .01) and nonviable (11.00%, p < .01; 4.33%, p < .01; 57.67%, p = .22; 54.33%, p = .72) dogs compared to healthy controls (44.7%, 70.05%, 84.00%, 63.95%). Fundic fluorescence was less in nonviable gastric tissue in comparison with viable gastric tissue (p = .03). Fluorescence of the gastrectomy staple line approximated that of viable tissue.

CONCLUSION

Near-infrared fluorescence can identify histologically confirmed nonviable gastric tissue.

CLINICAL SIGNIFICANCE

These results provide enough evidence to support the implementation of NIRF as an adjunct to gross examination of the gastric wall in dogs with GDV.

Endoscopic Removal of Gastric Foreign Bodies with a Bottle Liner in 12 Dogs (2020-2023)

Endoscopy is widely used to remove gastric foreign bodies using grasping forceps and loop snares to manipulate and retrieve the foreign material. However, as not all foreign bodies can be removed using conventional endoscopic techniques, this case series describes the use of bottle liners for the removal of gastric foreign bodies in 12 dogs between 2020 and 2023. A 4 oz bottle liner (Drop-Ins) was placed at the end of the endoscope and pushed into the stomach. With the help of forceps introduced into the operating channel, the foreign body was pushed into the bottle liner. The bottle liner containing the foreign body was then extracted with the help of traction threads. The technique was used as the initial retrieval method in 5 dogs because of smooth (i.e., difficult to grasp) or sharp (i.e., that may damage the digestive tract mucosa during removal) foreign bodies and as a rescue procedure in 7 dogs. Foreign body retrieval was successful in all 12 dogs, with minor complications reported in 5 dogs (erosions and bleeding of the gastroesophageal sphincter). The use of a bottle liner represents an affordable alternative to gastrotomy when foreign bodies cannot be grasped with forceps or snares.

Comparison of the results of sleeve gastrectomy, gastric pilication and liragulitide in obese rats

Obesity, which is generally seen in adults, is a serious health problem. Diseases caused by obesity are among the leading causes of death worldwide. Liraglutide (LG) is an analogue of glucagon-like peptide-1, which slows gastrointestinal motility, resulting in decreased food consumption. Gastric plication (GP) and sleeve gastrectomy (SG) is the reduction of stomach volume by surgical means. We examined and compared the body mass index (BMI) changes, metabolic changes and changes in gastric histology in obese rats after LG injection with surgical methods such as SG and GP. In this research, 35 Wistar Albino female rats were used. Rats were divided into 5 groups with 7 rats in each group. Group (G) 1: The control group, fed with a normal calorie diet for 8 weeks. G 2: Sham group, G 3: SG group, G 4: GP group and G 5: LG group, fed with high-calorie feed for 4 weeks. At the end of the 4th week, the study was terminated by making appropriate interventions for the groups. When the blood glucose (BG) levels measured at the beginning, 4th week and 8th week of the experiment were evaluated, it was monitored that the BG level at the 8th week was the lowest in the LG group (p<0.05). It was observed that the preop Ghrelin and Leptin levels of the LG group were lower than those of the SG and GP groups (p<0.05). As a consequenc As a consequence of our metabolic investigations, we observed that the use of LG is at least as effective as SG.

Evaluation of automated staple sizes on gastric layer incorporation and intraluminal pressure for partial gastrectomy closure in an ex vivo canine model

OBJECTIVE

To evaluate the performance of automated staple sizes on a cadaveric canine partial gastrectomy model.

METHODS

Stomachs were transected through the gastric body axis and randomly allocated to two closure groups: Group B, thoracoabdominal (TA) stapler 3.5 mm staple cartridge (blue); Group G, TA stapler 4.8 mm staple cartridge (green). After construct completion, leak testing was performed for both groups and compared. Initial leakage pressure (ILP), maximal leakage pressure (MLP) and leakage location were recorded. Staple lines were evaluated by direct observation and fluoroscopy to assess sub-mucosal layer incorporation and staple conformation. Staple shape was classified as optimal or suboptimal. Significance was set at p less than 0.5.

RESULTS

Following gastrectomy, the mean double gastric wall thickness was 7.82 ± 2.05 mm at the gastric body. Mean ILP was significantly lower in groups G (17.13 ± 1.19 mmHg) compared to group B (50.46 ± 6.03 mmHg, p = 0.0013). Similarly, mean MLP was significantly lower in group G (21.41 ± 1.39 mmHg) compared to group B (64.61 ± 10.21 mmHg, p < 0.0001). Although group G had higher percentage of B-shaped staple formation compared to group B, this was not significant (group G; 92.38%, group B; 54.56%; p = 0.054).

CONCLUSION

The 3.5 mm TA staple cartridge (blue) achieved superior bursting pressures compared with the 4.8 mm TA staple cartridge (blue) for the closure of a canine partial gastrectomy model. Both staple sizes incorporated all gastric layers. No differences were noticed in optimal staple conformation between groups. In vivo investigation is warranted to evaluate the use of different staple sizes on gastric tissue perfusion, successful healing and post-operative stasis and dehiscence.

Laparoscopic vertical sleeve gastrectomy in felines: A cadaveric feasibility study and experimental case series in two cats

OBJECTIVE

To evaluate the feasibility of laparoscopic vertical sleeve gastrectomy (LVSG) in feline cadavers using endoscopic stapling equipment and report clinical outcomes in two live feline subjects.

STUDY DESIGN

Cadaveric study and experimental case series.

ANIMALS

Ten feline cadavers; two feline subjects.

METHODS

LVSG technique was refined on feline cadavers and included retraction of the liver, dissection of the stomach, assessment of proper location for gastrectomy via stapling, and leak testing. Appropriateness of gastrectomy, gastrectomy %, surgical times and complications were recorded. The procedure was performed on two live feline subjects, and they were followed for 4 months to report surgical complications.

RESULTS

LVSG was completed in 9/10 cadavers and both live patients. Stenosis at the incisura was recorded in 2/9 cadavers. No obvious leaks were seen in the 8 cadavers that were tested or either live patient. The mean surgical time for all cadaver procedures and live patients was 110.4 and 115 minutes, respectively. Mean weight of resected cadaver stomach was 10 g and the mean % of the total stomach weight resected was 27.6%. No intra- or postoperative surgical complications occurred in the live subjects.

CONCLUSION

LVSG technique appears feasible and safe for use in live patients.

CLINICAL RELEVANCE

This LVSG technique may be safely used for partial gastric resection in cats. Further studies are necessary to determine if it is effective at reversing the effects of obesity and diabetes in this population.

Billroth II procedure for the treatment of spontaneous gastrointestinal perforation in two cats

CASE DESCRIPTION

A 9-year-old castrated male domestic shorthair cat (cat 1) and a 10-year-old castrated male Maine Coon cat (cat 2) were presented for recurrent feline lower urinary tract disease after receiving outpatient care from their primary veterinarians.

CLINICAL FINDINGS

Physical examination findings for both cats were initially within reference limits. After a short period of hospitalization, both cats developed peritoneal effusion; results of cytologic analysis of a sample of the fluid were consistent with septic peritonitis. During exploratory laparotomy, perforation of the pylorus or proximal portion of the duodenum secondary to ulceration was identified.

TREATMENT AND OUTCOME

Both cats underwent partial duodenectomy, partial gastrectomy (pylorectomy), and gastrojejunostomy (Billroth II procedure). The cats recovered from surgery and returned to a normal quality of life; however, each had mild episodes of anorexia but maintained a stable body weight. Cat 2 required additional surgery for trichobezoar removal 7 weeks later but recovered quickly. At 7 months after trichobezoar removal, cat 2 developed intermittent vomiting, but clinicopathologic, abdominal ultrasonographic, and upper gastrointestinal tract endoscopic findings were within reference limits. At 9 (cat 2) and 13 (cat 1) months after the Billroth II procedure, both cats were reported to be in good general health and without gastrointestinal signs.

CLINICAL RELEVANCE

In both cats, the Billroth II procedure was technically straightforward and associated with a full recovery and good medium- to long-term quality of life. A Billroth II procedure could be considered for treatment of cats with large mural lesions in the pyloroduodenal region.

Partial gastrectomy for resection of a gastric leiomyoma in a guinea pig (Cavia porcellus)

CASE DESCRIPTION A 4-year-old sexually intact male pet guinea pig (Cavia porcellus) was evaluated for a routine wellness examination. CLINICAL FINDINGS During physical examination, a small mass was palpated in the cranial aspect of the abdomen. Abdominal radiographic and ultrasonographic findings were suggestive of a gastric mass. Cytologic evaluation of a fine-needle aspirate of the mass was indicative of spindle cell proliferation most consistent with a sarcoma. TREATMENT AND OUTCOME The patient was anesthetized, and an exploratory laparotomy and partial gastrectomy were performed to resect the gastric mass. Histologic and immunohistochemical examinations of the mass revealed that it was a gastric leiomyoma. The patient recovered from surgery without complications. No evidence of mass recurrence was observed during an abdominal ultrasonographic examination performed approximately 19 months after surgery. CLINICAL RELEVANCE To our knowledge, this was the first report of the clinical diagnosis and successful surgical treatment of a gastric neoplasm in a guinea pig. Gastric leiomyomas are not uncommon in guinea pigs, and although benign, they can cause clinical signs if they become large enough to impair gastric function. Gastrointestinal surgery should be considered as a treatment option for guinea pigs with similar gastric neoplasms.

Gastropexy with an automatic stapling instrument for the treatment of gastric dilatation and volvulus in 20 dogs

Surgical stapling equipment was used to create a gastropexy in 20 dogs undergoing emergency surgery for gastric dilatation and volvulus (GDV). The technique involved creation of a tunnel between the seromuscular layer and the submucosa of the pyloric antrum, and a matching tunnel beneath the right m. transversus abdominis. The arms of a gastrointestinal anastomosis stapling device were introduced into the tunnels, and the device was fired to create the gastropexy. One dog died of systemic sequelae of GDV during the early postoperative period. None of the remaining 19 dogs developed a recurrence of GDV during follow-up periods ranging from 5 to 43 months. In 11 dogs, the integrity of the gastropexy was evaluated by abdominal ultrasonography and either negative contrast gastrography or double contrast gastrography; in these dogs, the radiographic and/or the ultrasonographic findings were suggestive of an intact gastropexy. There were no complications involving the gastropexy staple line. The results of this study indicate that an effective and consistent permanent gastropexy can be created, using surgical stapling equipment.

Gastric ulceration subsequent to partial invagination of the stomach in a dog with gastric dilatation-volvulus

CASE DESCRIPTION-An 8-year-old castrated male German Shepherd Dog was evaluated because of abdominal distension, retching, and vomiting. CLINICAL FINDINGS-Gastric dilatation-volvulus was suspected on the basis of the dog's signalment, history, clinical signs, and results of clinicopathologic analyses and abdominal radiography. Celiotomy was performed, and gastric dilatation-volvulus was confirmed along with splenomegaly. Gastric invagination was performed over an area of gastric necrosis. The dog was reevaluated 21 days later after an episode of collapse. Findings of physical examination and clinicopathologic analyses were suggestive of internal hemorrhage. Abdominal ultrasonography and subsequent celiotomy revealed severe gastric ulceration at the gastric invagination site, splenic torsion, and a focal splenic infarct. TREATMENT AND OUTCOME-Splenectomy and gastrectomy of the necrotic tissue were performed. The dog was discharged from the hospital, and the owner was instructed to administer gastroprotectants and feed the dog a bland diet. The dog was reported to be healthy 3.25 years after surgery. CLINICAL RELEVANCE-Findings suggest that complications associated with the gastric invagination procedure include severe gastric ulceration that may require subsequent surgery. Prolonged treatment with gastroprotectants following gastric invagination surgery may be necessary to avoid gastric ulceration in dogs.

Evaluation of laser Doppler flowmetry for measurement of capillary blood flow in the stomach wall of dogs during gastric dilatation-volvulus

OBJECTIVES

To validate laser doppler flowmetry (LDF) for measurement of blood flow in the stomach wall of dogs with gastric dilatation-volvulus (GDV).

ANIMALS

Six purpose-bred dogs and 24 dogs with naturally occurring GDV.

STUDY DESIGN

Experimental and clinical.

METHODS

Capillary blood flow in the body of the stomach and pyloric antrum was measured with LDF (tissue perfusion unit (TPU) before and after induction of portal hypertension (PH) and after PH plus gastric ischemia (GI; PH + GI) and compared with flow measured by colored microsphere technique. Capillary flow was measured by LDF in the stomach wall of dogs with GDV.

RESULTS

PH and PH+GI induced a significant reduction in blood flow in the body of the stomach (P = .019). A significant positive correlation was present between percent changes in capillary blood flow measured by LDF and colored microspheres after induction of PH + GI in the body of the stomach (r = 0.94, P = .014) and in the pyloric antrum (r = 0.95, P = .049). Capillary blood flow measured in the body of the stomach of 6 dogs that required partial gastrectomy (5.00+/-3.30 TPU) was significantly lower than in dogs that did not (28.00+/-14.40 TPU, P = .013).

CONCLUSIONS

LDF can detect variations in blood flow in the stomach wall of dogs.

CLINICAL RELEVANCE

LDF may have application for evaluation of stomach wall viability during surgery in dogs with GDV.

Clinical evaluation of a right-sided prophylactic gastropexy via a grid approach

A new technique is described for a prophylactic incisional gastropexy via a right-sided grid approach (i.e., minilaparotomy). A pilot study showed comparable tensile strength between a traditional ventral midline approach and the grid approach. Six client-owned dogs were selected for the procedure. Four weeks postoperatively, a barium gastrogram was performed to assess stomach/gastropexy position. Complications included a seroma and postoperative discomfort. This technique should be considered for any at-risk breed that is not overweight. The right-sided grid approach to a prophylactic gastropexy was less invasive than a ventral midline approach and resulted in a stable gastropexy at 4 weeks postoperatively in five of six dogs.

Gastric surgery with surgical stapling instruments

The use of stapling instruments to perform gastric surgery in small animal patients provides alternative techniques that are often more reliable and are usually performed more quickly than conventional techniques with manual sutures. In addition to reducing anesthetic and operating times, the risk of contamination of the abdominal cavity may be decreased significantly.

Gastric dilatation volvulus. Surgical prevention

Definitive surgical management of gastric dilatation volvulus involves gastric repositioning, gastric resection when indicated and surgical formation of a permanent adhesion to prevent recurrence of the problem. Derotation and gastropexy procedures are recommended as soon as the patient is a reasonable anesthetic risk. Splenectomy and pyloric outlet procedures are of questionable value in preventing recurrence in the majority of cases. In North America, most veterinary surgeons perform right-sided antral gastropexy as a means of preventing recurrence. The technical advantages and disadvantages and experimental and clinical results of several techniques, including the tube gastrostomy, incisional gastropexy, circumcostal gastropexy, and belt-loop gastropexy, are discussed.

Gastric extramedullary plasmacytoma in a dog

A 10-year-old mixed-breed dog was examined because of a 6-week history of daily vomiting and sporadic diarrhea. On gastroscopy, a crateriform mass was observed on the greater curvature of the stomach. Partial gastrectomy and lymphadenectomy of a large mesenteric lymph node was performed. Gastric plasmacytoma with lymph node metastasis was diagnosed by histologic and immunoperoxidase methods, and chemotherapy was initiated with doxorubicin hydrochloride and diphenhydramine hydrochloride. The dog remains clinically normal 30 months after initial diagnosis. Although gastric plasmacytomas are rare in dogs, long-term survival appears to be better with this disease than with other types of gastric neoplasia.

Partial gastrectomy with an automatic stapling instrument for treatment of gastric necrosis secondary to gastric dilatation-volvulus

A gastrointestinal anastomosis stapling instrument was used to perform partial gastrectomy in nine dogs undergoing emergency surgery for gastric dilatation-volvulus. The amount of necrotic stomach resected was 20% to 50%. Permanent gastropexy was performed, and six dogs also required partial or total splenectomy. Six dogs (67%) were normal after surgery, with follow-up periods of 6 to 16 months for five dogs. One dog died and two dogs were euthanatized because of postoperative complications unrelated to the surgical technique. There were no complications involving the partial gastrectomy staple line.

Eructation of gas through the gastroesophageal sphincter before and after gastric fundectomy in dogs

The gas eructation function of the gastroesophageal sphincter (GES) was investigated in 6 conscious, fed dogs before and after gastric fundectomy. Using a perfused 4-lumen catheter with a Dent sleeve, gastric and GES pressures were measured. To induce eructation, nitrogen gas was insufflated (440 ml/min) into the stomach through one channel of the catheter. After base-line studies were completed on each dog, fundectomy, to remove 30% of the stomach, was performed. Mean (+/- SEM) GES pressure was 45.3 +/- 3.3 mm of Hg before fundectomy and 41.4 +/- 1.9 mm of Hg after fundectomy (P greater than 0.05). Before fundectomy, treatment with metoclopramide or cisapride increased GES pressure to 62.2 +/- 4.1 mm of Hg (P less than 0.001) and 61.1 +/- 5.0 mm of Hg (P less than 0.05), respectively. Gastric contraction rates were the same, 4.92 +/- 0.24/min and 4.80 +/- 0.16/min before and after fundectomy, respectively. During insufflation, gastric pressures before eructation increased to 12.2 +/- 1.3 mm of Hg before fundectomy and to 13.6 +/- 0.9 mm of Hg after fundectomy (P greater than 0.05). Eructation occurred at intervals of 1.44 +/- 0.20 minutes before fundectomy and 1.56 +/- 0.13 minutes after fundectomy (P greater than 0.05). Before fundectomy, administration of metoclopramide or cisapride resulted in eructation intervals of 1.72 +/- 0.21 minutes and 1.39 +/- 0.02 minutes, respectively; these intervals were not significantly different from those measured in dogs not given drugs. After fundectomy, the GES pressure in 5 dogs decreased and remained low during insufflation. After a series of normal eructation intervals, multiple eructations were observed in 4 of these dogs. Fundectomy did not impair ability to eructate gas from the stomach.

Chronic hypertrophic pyloric gastropathy as a cause of pyloric obstruction in the dog

Six small-breed, middle-age dogs with a history of chronic intermittent vomiting had benign pyloric lesions causing gastric outlet obstruction. Marked similarities were found in clinical signs, pathologic changes, and treatment results. The condition was classified as a syndrome and was named chronic hypertrophic pyloric gastropathy. The appearance of the obstructive lesions at surgery were various forms of mucosal hypertrophy. Microscopically, the syndrome was characterized by mucosal foveolar and glandular hyperplasia, cystic glandular dilatation, superficial mucosal ulcerations, and various cellular infiltrates. The affected dogs were successfully treated by surgical correction of the gastric outlet obstruction.