Prophylactic Gastropexy
by Karen Leshkivich DVM
ABC Bulletin 1994

How many times have you hear this term?  It may be a lifesaving procedure for your dog.  What it consists of is tacking the stomach in place so that it will not rotate, before your dog has a GDV (gastric dilatation and volvulus) or bloat incident.  It makes a lot of sense to do a surgery while your dog is healthy and stable and with minimal anesthetic risk versus an emergency surgery when your dog has bloated or is in a full GDV crisis.  High surgical risk factors during GDV include impairment of blood flow back to the heart, restricted blood flow to the stomach (possibly causing death of part of the stomach) and multiple factors including shock and cardiac arrhythmia's that can cause death.

A gastropexy will not prevent your dog from bloating but it will decrease the probability of bloat by allowing your dog to burp and pass excess gas through the stomach to the rest of the intestinal tract.  But a gastropexy, if done correctly, will prevent the stomach from turning  on its axis, resulting in a critical, life threatening situation.  Bloat itself can kill your dog but not as quickly as GDV will kill him.  If the stomach cannot rotate, the time your dog has gained, even during the bloat episode, may be enough to save his life.

Prophylactic gastropexy is not for everyone, but if your dog is in a high risk category, then it is recommended.  It is difficult to define exactly what is the high risk category, since the exact causes of GDV are not yet known, but there are some factors that I feel should be considered.
High risk factors are:
1) previous episodes of bloat
2) tends to be gassy
3) aerophagic (gulps air while eating or under stress)
4) left alone for long periods of time unobserved
5) under stress (showing, tracking, working, change of environment, bitches in heat, etc.)
6) won't conform to the ideal feeding and resting schedule (runs after eating meals, excitable, etc.)
7) gobbles food
8) conformation (very deep chest, large chest, etc.)
9) familial history of bloat of GDV
The last few items dealing with conformation and relatives may or may not be factors, but if combined with any other factors, may be significant.

A new method of gastropexy (published in the JAVMA Nov 1993) is a very simple and fast technique to fix the stomach to the ventral abdominal wall.  Of the current techniques (tube gastronomy, circumcostal ad belt-loop), this new one is the most anatomical correct for placement of the stomach and may cause less disturbance of the normal stomach movements during digestion.  The very short period of time required to perform this procedure makes it even more encouraging for a prophylactic procedure and also makes much more sense during a crisis of GDV where time is of the essence.

I feel very strongly that if your dog has a GDV crisis, a gastropexy is not a prophylactic procedure---it is a necessity.  I have heard many people being advised that, after the bloat is controlled, the stomach is derotated and the dog stabilized, the surgery is not necessary and the dog can be medically managed.  If your dog bloats, he will bloat again.  It may not be in the next week, or the next month; it may not even be for years, but there is greater than 80% chance that he will bloat or have a GDV crisis again...and you may not be home when it happens. It may sound like I am trying to scare people, but I have seen many cases come through the hospital and have had experience with my own hounds.  One of my dogs had a GDV incident, and we were able to decompress the stomach and stabilize him without emergency surgery.  I was at home and my local vet did not believe in gtastropexy surgery once the GDV crisis was resolved.  After discussing my dog's case with surgeon's and internists at the veterinary hospital, I decided to go ahead and have a gastropexy done on my dog two weeks after the GDV incident.  When we opened him up to do the gastropexy, we found that his stomach was still 90% rotated.  Now this was two weeks after the GDV, and I was lucky that he hadn't had another GDV crisis during the time when I was trying to decide whether or not to have the gastropexy done.

If your dog has a GDV episode, a gastropexy should be done.  I don't think that there should be any other course of action.  If you have the time to stabilize your dog fully  before having the surgery done, wait to have it done...but do have a gastropexy done.

I have had my dogs gastropxied prophylactically because I feel that they are in the high risk category.  I am not at home for long periods of time during the day and they attend shows.  And I prefer to have a simple surgical procedure done on them when they are healthy, and if they do succumb to bloat at sometime, this simple procedure may save their lives.