Surgery Overview

GASTRIC/INTESTINAL VOLVULUS AND TORSION

GENERAL INFORMATION

Most common signalment: large breed, deep chested dogs.
Injection of fluorescein dye is not a reliable indicator of gastric wall viability.
Prep caudal thorax and entire abdomen.
Pre-operative prep should include shock fluid therapy.
Administer fluids, antibiotics and decompress before taking radiographs.
Take right lateral and DV radiographic views.
Do not give bicarbonate unless you can measure a blood gas.

MOST COMMON COMPLICATIONS AND DIFFICULTY

Insufficient treatment of hypovolemia and hypotension.
Failure to identify necrotic areas of stomach on the dorsal surface of the fundus. Must enter omental bursa to see this area. Must also have an abdominal incision that extends to the xiphoid to allow examination of the region of the cardia.
Gastric necrosis increases the likelihood of mortality in these patients.
High lactate concentrations may be an indicator of gastric necrosis.
Rotating the stomach the wrong direction.

Temporary gastrotomy. Usually a reverse 7 local block or direct infiltration over the proposed incision can be used. Make a full thickness incision in the right paracostal body wall and identify the stomach. Suture the stomach to the skin using a simple continuous pattern. Make an incision in the stomach.

"EXPERTS' ADVICE"

Place a large bore oral gastric tube during surgery to allow decompression of the stomach.
Gastropexy is mandatory in these patients.
The spleen is an innocent bystander. It does not generally have to be removed but if in doubt you can take it out!
The presence of the omentum draped over the gastric wall on entry to the abdomen indicates that the stomach is rotated. The direction of rotation is generally 270º clockwise. Derotate in a counterclockwise direction.

After derotation of the stomach, it should be anchored to the right abdominal wall with an incisional gastropexy. The seromuscular layer of the stomach is incised for a length of 3-4cm and a similar incision is made through the transverse abdominal muscle on the right abdominal wall approximately 3cm off the midline. You can use either PDS* II or PROLENE* suture material in a simple continuous pattern to anchor these two bleeding surfaces together.

GASTRIC/INTESTINAL VOLVULUS AND TORSION:
SUTURE AND NEEDLE OPTIONS

Brand

Needle Type

Needle Reference

Main Choice

Also Possible

Main Choice

Also Possible

STOMACH

PDS* II

PROLENE*

Taper Point

RB-1, SH-1, CT-2. CT-1

LINEA ALBA

MONOCRYL* (young)

PDS* II (adult)

VICRYL* PLUS

Taper Point

Reverse Cut

SH-1, SH, CT-2, CT-1

RB-1, CT-3

FS-2, FS-1, FS, FSL, X-1, CP-2, CP-1

SUBCUTANEOUS

Taper Point

RB-1, SH, CT-2, CT-1

SKIN CLOSURE

ETHILON*

PROLENE*

Silk

Reverse Cut

FS-2, FS-1, FS

FSL, CP-2, CP-1, KS

Blue type indicates Reverse Cut

	Cat/Small Dog (20 lbs or less)	Medium Dog (20-45 lbs or less)	Large Dogs (50 to 75 lbs)	Giant Dog (75 lbs +)
STOMACH	3-0	3-0 or 2-0	2-0	2-0
LINEA ALBA	3-0	3-0 or 2-0 or 0	2-0 or 0	0 or 1
SUBCUTANEOUS	4-0	4-0 or 3-0	3-0 or 2-0	2-0
SKIN CLOSURE	4-0	4-0 or 3-0 or 2-0	3-0 or 2-0	2-0

	Use the suture selection tool for specific product code recommendations.

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