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

Abstract

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.

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

“…In our study, the efficacy of TLG‐SS to obtain an adhesion was not different from TLG‐Vloc gastropexy. Similar ultrasound evidence did not differ from previous published papers, 13,16,31 even if a TLG was performed with a single simple continuous pattern 18,20,21 …”

“…Moreover, lower intrabdominal pressure facilitates moving the pyloric antrum to the abdominal wall allowing less tension for suturing and straps' deployment. Also, external pressure could be easily provided by an assistant's hand during the suture biting or straps application at this pressure, as recently suggested by Deroy et al 21 …”

“…30 Moreover, lower intrabdominal pressure facilitates moving the pyloric antrum to the abdominal wall allowing less tension for suturing and straps' deployment. Also, external pressure could be easily provided by an assistant's hand during the suture biting or straps application at this pressure, as recently suggested by Deroy et al 21 The integrity of gastropexy was evaluated by ultrasound, as previously described. 14,20 Ultrasound of all the gastropexies showed adhesion of the stomach and body wall layers at the time of assessment.…”

“…Similar ultrasound evidence did not differ from previous published papers, 13,16,31 even if a TLG was performed with a single simple continuous pattern. 18,20,21 The tensile strength could not be measured in this study because dogs were client-owned. The mechanical strength of gastropexy cannot be determined by ultrasonography, but in our previous ex-vivo study, 32 the reported mean range of the maximum load to failure of the acute gastropexy did not differ using TLG-SS (31.43 N) or TLG-Vloc (39.18 N).…”

“…21 The use of barbed sutures has been described as a knotless technique feasible for laparoscopic gastropexy, reducing gastropexy time and surgeons' learning curves. [14][15][16]20,21 The Ethicon Securestrap Absorbable Strap Fixation Device (SS; Ethicon US, LLC, Ethicon, Inc., Somerville, NJ, USA) is a mechanical fixation device designed to secure prosthetic materials to soft tissue. This study aimed to evaluate the feasibility and efficacy of a laparoscopic absorbable fixation device (Securestrap, Ethicon) in TLG compared with a simple continuous suture pattern performed with a knotless barbed suture.…”