What is a Gastropexy? Why did Charlie have one? Why did he need two?
Working in the world of pets, you happen to come across the tragedy of a family losing one of their beloved members to something preventable. Bloat and/or gastric torsion is one of those medical
conditions that take our pets before their time. This is also referred to in the medical world as Gastric Dilatation-Volvulus or GDV. A surgery called gastropexy can treat or prevent GDV. Before we talk about gastropexy, what is GDV exactly, and how can it be fatal?
GDV is a two-part disorder. The dilatation part of GDV is caused by air, gas, and fluid accumulation in the stomach. The air accumulation most likely is caused by swallowing a lot of air. The gas is most often increased by the fermentation of bacteria and the production of gas from the stomach acids. Fluid accumulation can occur when the dog drinks a lot of water, the stomach increases its acidic secretions, and/or there is an obstruction in the outflow of the stomach. The stomach can become so dilated it can rotate in the abdomen, causing the condition medically known as volvulus.
Gastric dilatation or bloat can occur without volvulus happening; however, the dilatation could be caused by volvulus. GDV has been recognized in dogs for a very long time, unfortunately its exact cause is not understood. The medical world can only identify risk factors:
Dogs with a first relative with GDV.
Large and giant breeds, especially those with a deep chest.
Ingestion of large amounts of food and/or water.
Too much activity after eating or drinking.
Dogs that have had their spleen removed.
GDV is a very serious condition and often has severe consequences. It can prevent blood return to the heart from the abdomen, rupture the stomach wall, increase pressure on the diaphragm preventing the lungs from expanding properly, and prevent blood flow to the spleen, kidneys, and intestines. If left untreated, most dogs will not survive GDV.
Symptoms can include: increased heart rate, weak heart rate, pale mucous membranes, abnormal breathing, excessive panting, distended abdomen, turning to look at or bite the flank area, drooling, standing and stretching, anxiety, retching without producing anything (volvulus), or retching with producing something (dilatation without volvulus). This all sounds like something you want to avoid, right? Researchers don’t really know why GDV happens, so it’s hard to say any one thing will prevent it from happening. Here are a few things that can help lower your risk of GDV:
Feed your dog smaller more frequent meals.
Avoid exercise for 1 full hour after eating or drinking large amounts of water.
Slow your dogs’ meal down. When dogs eat their food really fast, they also swallow a lot of air.
Not all carbs are equal. Some carbohydrates ferment more than others. Avoid corn, wheat, soy, oats, and rice.
Having a surgeon perform an elective gastropexy on your dog.
A gastropexy is a surgical operation in which the stomach is sutured to the abdominal wall. There are several ways to have a gastropexy performed, and this would be a very long blog post if I covered all of them; instead, I will only discuss incisional gastropexy. The dog’s abdominal area is shaved along with a patch on the front leg. The incision is made from the base of the sternum to the pubis, then through the magic of a surgeon, the stomach is sutured to the abdominal wall near the 13 rib.Your dog will then be stitched back up and put on limited activity for the next 10-14 days. The gastropexy will prevent volvulus, but does not prevent dilatation. Dogs that have a gastropexy done have up to a 4% chance of developing GDV.
In other words, gastropexy significantly reduces the occurrence of GDV. However, this is a major surgery, and it’s important to understand what might happen. The incision is long, there is a shifting of the organs, and as with all surgeries there are risks. In addition to infection, there is also the risk of rib fractures, a puncture of the diaphragm, lung collapse, seroma (pocket of fluid that usually goes away on its own), aspiration pneumonia, vagal nerve injury, and longer times under anesthesia. There is a 1% mortality rate in dogs without GDV that have an elective gastropexy done. I wished I had known all of these risks before Charlie had surgery. I only assumed the biggest risk was that of infection. I had to do some very serious digging to find all these risks. At first look, gastropexy appeared to be a virtually risk-free surgery.
When I brought Charlie home, I already knew a few of the things I wanted to do for him to help prevent as much as possible. I wanted to avoid bone and joint issues, so not only do I feed him joint supplements but I delayed his neuter until after 2 years old. I exercise him every day, not just because it allows him to be a better-behaved dog, but because it prevents him from being overweight and obese. He has a tendency to chase cars, so I have spent hours on counter-conditioning and I also do not allow him to be outside by himself. Given his size, deep chest, his love for running and jumping, his sloppy way of gulping water, Charlie is at risk for GDV. I knew I needed to do what I could to prevent it. Since bringing him home, I have fed him small frequent meals, kept him confined to his crate for at least an hour following all his meals, and I feed him a grain free diet.
I first heard about a gastropexy about 4 years ago when a dog I had been working with suddenly passed from GDV. The owners were devastated, and immediately adopted a new dog. To avoid the same tragedy their veterinarian recommended a gastropexy. I was immediately intrigued, and did some brief looking into it. The advice on the online resources I found recommended having an elective gastropexy done at the same time your dog is neutered or spayed. This way an owner would reduce the amount of times their dog is under anesthesia, avoid emergency surgery, and save on the cost of multiple surgeries. The surgery by itself can be expensive. The cost ranges from $400-$4000 depending on if it’s non-emergency or emergency. I talked with a vet tech in detail about the benefits vs. risks of the gastropexy and decided to go forward with having Charlie neutered and an elective gastropexy done at the same time. By combining them I was able to save about $400. Other than infection the above risks were not discussed at that time.
In late October of 2018 I called my vets office and scheduled the surgeries for November 29, 2018. Two weeks before his surgery I took him in for blood work. The day of the surgery he couldn’t eat or drink any water starting at 12:00am. Drop off was between 8:30am and 9am and I was able to pick him up anytime after 3pm. At drop off they led me into an exam room where I needed to sign some papers. The surgeries were both briefly described to me along with expected recovery times and follow up incision care. There were no risks discussed at that time. Charlie was taken away and I was free to go. They promised to call when his surgery was done. I kept myself busy and tried not to worry or think too much about it. 3pm came and went, and still no word from the vet’s office. I got there about 3:30 and was filled in on a complication during his surgery.
As it turns out, anatomy can differ by a few inches according to the standard, and Charlie’s diaphragm was not exactly where the doctor was expecting it to be. During the gastropexy, his diaphragm was punctured. Luckily, she caught it quickly, repaired the puncture and was able to finish the gastropexy. The surgery took much longer than was expected and Charlie was having a hard time waking up from the anesthesia. His reflexes were poor, he was having a hard time walking, and in general felt really bad. The office stayed open late for me while we waited for Charlie to make improvements. The office staff was very caring and concerned for our well-being. We were sent home with some extra instruction on what to look for in case of further complications. Charlie continued to improve overnight and didn’t show any sign of difficulty breathing or digestion. I wish it could have all been over from there. Unfortunately, Charlie was not done with the complications.
Almost immediately I knew something was not right with him. He was not acting himself, which could have been explained away by the medications he was on (Trazadone; a mild sedative), or even just recovering from a major surgery. I took him in five days following his surgery to get re-checked by the vet; I was concerned with some of his behaviors. He kept trying scratch or bite at his flank area, he would suddenly try to bolt out of the room, he would try very hard to throw himself into the walls and furniture, he was walking differently as if he was very uncomfortable, lots of stretching, tenderness in his abdominal area, and no desire to do anything. In the exam room, he was behaving very aggressively towards the veterinarian. After a brief exam, and lots of talking about his behavior, it was believed that all of his strange behavior could be explained by the Trazadone and the recovery of surgery. The advice was simple, stop giving him the medication and continue to monitor his recovery. It took a few days for the medication to leave his body, and he did stop doing some the weird things, like trying to bolt out of the room and in general seemed more comfortable. I started to feel more comfortable.
On day 11 following his surgery, he was scheduled to go back and have his stitches removed. All looked great! Both of his incisions had healed well, his breathing and heart rate were great, and he seemed to have stopped behaving strangely. We got the thumbs up to slowly increase his activity. Very shortly after we got home from his vet visit, he vomited bile. The following day, in the afternoon, he vomited bile again. I called the vet office and had a bad feeling. They got back to me and said they didn’t feel concerned yet, but to keep an eye on him. They recommended an over-the-counter antacid. I did not have any on hand, and chose not to give him any. He didn't seem to be in any discomfort the rest of that day, and I felt it had resolved on its own. On day 15 following his surgery (Saturday December 15), I came home from a training session and my husband told me Charlie had been whining the whole time I was gone. I took him out to the bathroom as soon as I could and he seemed very uncomfortable. He was whining, stretching, kept trying to lay down, staring at me, burping with a very strong sulfur smell, and after about 5-10 minutes he started vomiting and wouldn’t stop. 10 minutes later I was on the phone with the vet. They were supposed to close in about a half hour, but wanted to see him right away, and stayed open late for us to get there. After x-rays they diagnosed him with gastric dilatation. I was so overwhelmed and worried all I could do was cry. The doctor didn’t know what could have caused it, but felt that she was not the most experienced person to do exploratory surgery. She sent me immediately over to Veterinary Care Specialist (VCS) in Milford Michigan.
At VCS they ran several tests on him including blood work, x-rays, and abdominal exam. The surgeon at VCS wanted to start with medications that would reduce the bloat before doing surgery. She wanted to keep him under close supervision for the next few days and try to avoid surgery. She kept me closely updated over the next 15 hours, and unfortunately Charlie wasn’t responding well enough to the medications. Sunday morning she decided to move forward with emergency surgery. She wasn’t sure exactly what the problem was, so the surgery was going to be exploratory. Once she was able to get a close look at what was happening with his body, she was able to see his original gastropexy was too high for his anatomy and was causing a poor outflow of the stomach. She repositioned the gastropexy and felt confident it would fix any further issues.
These are a few photos taken of Charlie during his recovery. The photo on the right is a few hours after his second gastropexy, below is his incision 12 days following his his second gastropexy, and bottom right is the side view of his shaved abdomen 8 days following his second gastropexy.
Charlie stayed at VCS for a few days and was kept under close observation the whole time. I was able to go and sit with him in an exam room for short periods of time. I was very happy when I could finally bring him home. His recovery from the first surgery compared to the second surgery has been night and day. When he came home, he picked up his ball for the first time in three weeks and was eager to play. He had his normal trot when he walked and had his normal happy attitude on life. He didn’t show any of the strange behaviors I saw with the first surgery. On day 12 following his second surgery (December 28) his stitches were removed, his incision healed well, and he’s now back to normal activity. One day shy of an entire month! He was very happy to get back to taking regular long walks, running, chasing the ball, and even a barn cat or two. ;)
On the third day following his second surgery, my vet office called to check on his recovery. They were relieved to hear of his progress, and informed me they were postponing any further gastropexies until they could understand how they could prevent what happened with Charlie from happening again. I thought it showed a lot of integrity on the part of my vet to know she performed the surgery according to how it should have been done, to recognize that Charlie’s problem needed the care of someone with better experience, and to seek further experience before performing the surgery again. She covered the cost of all of his care at VCS. I hold no ill feeling towards her or her office, and have intentionally kept the name of her and her office anonymous in this post.
Looking back at this experience, of course if I knew it would all work out the same, I would choose to not have the gastropexy performed. After all the research I have done on it, I don’t think I could even recommend gastropexy to others. I wish I had been better educated on what was going to happen during the surgery and what all the risks were. If I had all the information, I’m not sure if I would have gone forward with the gastropexy. If you think your dog could be high risk for GDV, I strongly urge you to talk to your veterinarian to discover if this is the right step for you. If you choose to have an elective gastropexy done on your dog, I would encourage you to seek treatment from a highly experienced surgeon.