Gastropexy

Gastric Dilatation-Volvulus (GDV) is an acute, fast-developing, and potentially fatal condition in dogs that demands immediate veterinary intervention. Although its causes are multiple, it is frequently linked to the rapid consumption of large quantities of food. The accumulation of food and gas leads to marked enlargement and distension of the stomach, which can result in several serious complications, such as:

• obstruction of normal blood flow returning from the abdominal organs to the heart
• reduced blood supply to the stomach lining
• tearing or rupture of the stomach wall
• compression of the diaphragm, limiting lung expansion and impairing normal breathing

In some cases, the stomach enlarges to the extent that it twists around its axis, a condition known as gastric volvulus. This twisting can obstruct blood flow to both the stomach and the spleen. As gastric dilatation progresses and systemic effects persist, secondary complications may develop.

Reduced respiratory function and decreased cardiac output throughout the disease process impair oxygen delivery to tissues (hypoxia), leading to cell death in vital organs such as the liver and kidneys.
Abnormal heart rhythms (cardiac arrhythmias) are frequently observed as a result of hypoxia.
The lining of the entire gastrointestinal tract is susceptible to tissue death and sloughing.
Damage to the gastrointestinal tract may allow bacteria to enter the bloodstream, resulting in bacteremia and potentially sepsis.

Multiple studies have examined the causes and risk factors associated with GDV in dogs. While the syndrome is not fully understood, it is known to be more commonly associated with dogs that:

• have a deep chest conformation (high thoracic depth-to-width ratio)
• are fed one large meal per day
• are older in age
• have close relatives with a history of GDV

Additional factors thought to increase risk include elevated feeding positions, prior splenectomy, large or giant breed size, and stress. A study published in 2006 also found that dogs consuming dry foods listing oils (such as sunflower oil or animal fat) among the first four ingredients are at increased risk if they are already predisposed.

Although GDV has been reported in nearly all dog breeds, it is most commonly observed in Great Danes, Weimaraners, St. Bernards, Irish Setters, and Gordon Setters.

Early clinical signs are typically related to abdominal discomfort and may include:

• signs of anxiety or frequent looking at the abdomen
• standing with stretching behavior
• excessive salivation
• visible abdominal enlargement
• non-productive retching

As the condition advances, dogs may begin to pant, develop pronounced abdominal bloating, become weak, collapse, and remain recumbent. Physical examination often reveals elevated heart and respiratory rates, weak pulses, delayed capillary refill time, and noticeable abdominal distension.

Any pet showing these signs should be examined by a veterinarian immediately. Once GDV is diagnosed, surgical intervention is required. Early stabilization and surgery significantly improve outcomes, as mortality rates increase with disease severity. Referral to an ACVS board-certified veterinary surgeon may be recommended.

Initial diagnostic testing typically includes a complete blood count (CBC), serum chemistry panel, electrolyte analysis, and urinalysis to identify concurrent metabolic disturbances and rule out other diseases with similar clinical signs.
Abdominal radiographs are essential to confirm the diagnosis, while an electrocardiogram (ECG) is used to detect cardiac arrhythmias, which often appear later in the disease. Blood gas analysis is commonly performed to assess the severity of respiratory compromise. Additional diagnostic tests may be recommended at the discretion of the veterinary surgeon.

Because GDV patients often experience significant cardiovascular instability, pre-anesthetic stabilization is usually required and may include intravenous fluid therapy and supplemental oxygen. If splenic blood vessels have been damaged due to torsion, blood transfusions may be necessary to manage internal hemorrhage.

Gastric decompression is typically performed next by passing a tube through the esophagus into the stomach to release trapped gas and fluid, often followed by gastric lavage to remove remaining food material. In some cases, percutaneous needle or catheter decompression is necessary to allow tube placement. The timing of anesthesia and surgery depends on patient stability and surgical judgment.

Surgical treatment includes complete abdominal exploration and correction of stomach rotation. The surgeon evaluates the viability of the stomach, spleen, and surrounding organs. If required, partial removal of the stomach (partial gastrectomy) or spleen (splenectomy) is performed. Once repositioned, the stomach is permanently attached to the abdominal wall (gastropexy) to prevent future volvulus.

Possible intraoperative and postoperative complications include low blood pressure, bleeding, infection, suture failure, cardiac arrhythmias, shock, and death. Most dogs remain hospitalized for several days with continuous monitoring, including cardiac activity. Temporary arrhythmias are common and usually resolve without treatment.

Severe complications may result from reperfusion injury, which occurs when toxic metabolites are released after the stomach is untwisted, potentially causing arrhythmias, acute kidney failure, or liver failure. Prolonged shock can lead to organ failure, clotting disorders, or death. Greater disease severity and longer duration before treatment are associated with increased complication and mortality rates.

The overall reported mortality rate for GDV is approximately 15%. Higher mortality has been linked to dogs:

• showing clinical signs for more than six hours
• exhibiting preoperative cardiac arrhythmias
• requiring partial stomach removal
• requiring splenectomy

Postoperative care includes activity restriction for several weeks. Long-term management typically involves feeding two to three smaller meals daily instead of one large meal and continued monitoring for recurrence.

Some dogs may still experience gastric dilatation without volvulus after surgery, particularly following consumption of large meals. While gastropexy does not prevent stomach expansion, it effectively prevents life-threatening torsion.

As a preventive strategy, prophylactic gastropexy is widely recommended for high-risk breeds and dogs with affected relatives. This procedure is often performed during routine sterilization surgeries and can be accomplished using minimally invasive techniques such as laparoscopic-assisted, endoscopic-assisted, or limited-approach gastropexy.