Evaluation of biomechanical traction of incisional gastropexy and scarification gastropexy techniques in dogs

Abstract

Background: Gastropexy is used to correct gastric dilatation volvulus, a disease that usually affects large and giant dogs and leads to death in 23.4 - 43% of patients. This study aimed to evaluate the biomechanical traction of 2 gastropexy techniques, incisional gastropexy and scarified gastropexy, in 10 dog cadavers. Incisional gastropexy comprises a single incision in the abdominal wall and another incision in the stomach wall in the pyloric region followed by simple continuous sutures. The scarification technique creates scarification along the stomach borders of the pexy. Thereby, knowing that both techniques are successful, the biomechanical traction of each technique was compared. Materials, Methods & Results: A total of 10 animals without defined breed weighing from 6.4 - 43.0 kg were allocated into 2 equal groups (GE [scarified gastropexy] and GI [incisional gastropexy]). Incisional gastropexy was performed with a simple continuous suture pattern in the GI group and scarified gastropexy with an interrupted simple suture pattern was performed in the GE group. Absorbable 2-0 monofilament yarn (polygllecaprone 25) was used for sutures in both groups. Rectangular segments of the gastric antrum were collected from the right abdominal wall and from the bottom of the stomach at the left abdominal wall, which were subjected to a traction test. The scarification technique was easier, faster, and used less surgical sutures than the incisional technique. Both techniques were effective regardless of the site applied, with no significant differences. There was a difference in stretching depending on location. Discussion: The pathogenesis of gastric dilatation volvulus (GDV) is unknown. However, gas accumulation inside the gastric chamber may lead to organ dilation and consequently cause torsion of the cardia region and pyloric antrum, resulting in strangulation of blood vessels and nerves. This torsion could cause stomach ischemia followed by organ necrosis if early emergency care is not provided. In addition, vessel strangulation my lead to a systemic syndrome resulting in shock. The disease presents acute and non-specific clinical signs such as weight loss, vomiting, and abdominal intumescence. Patients with risk factors such as reduced gastric motility, delayed stomach replenishment, lower weight, advanced age, or presence of a foreign body may present with poor prognosis. Once GDV becomes an emergency, surgical correction with the most efficient surgical techniques and procedures is necessary to guarantee patient survival. Based on the results obtained, both the scarified and incisional gastropexy techniques are more efficient than other techniques. In addition, the scarified technique with interrupted simple stitches stood out when compared to the incisional technique with a continuous simple suture pattern as it was faster and used less suture thread. The incisional technique, on the other hand, provides good juxtaposition of the edges of the wounds, avoiding the exposure of muscle tissue, as well as adhesions from other organs. The knowledge of those factors promotes positive effects on the effectiveness of an emergency surgical approach for patients with GDV, since it allows less surgical time, as well as less anesthetic time. Based on the results obtained during the biomechanical traction tests of the study, it was concluded that both scarified gastropexy with interrupted single stitches and incisional gastropexy with a continuous single stitch may be efficient. The scarified technique stood out when compared to the incisional technique as it required less time and used less sutures.