Lucky Nikko Gets Laparoscopic Gastropexy to Prevent Possible Life Threatening Problem

Nikko is a wonderful, seven month old black standard poodle puppy who loves to be rocked to sleep in dad’s lap. When he’s not sleeping with his dad, he likes to run around and have fun. He has recently discovered the pond near his house where he likes to investigate the ducks, and he also enjoys trips to the beach. Nikko’s parents knew that having him neutered would prevent many health problems such as prostate disease and certain tumors, and also make him more content to stay at home. During his puppy physical examinations, Dr. Plankenhorn recognized that Nikko would grow up to be a large, deep chested dog, both risk factors for developing bloat. Dr. Plankenhorn recommended that he have preventive gastropexy at the same time he underwent surgery for neutering. 

Gastropexy is a surgical procedure where the stomach is sutured to the body wall in order to prevent twisting of the stomach during what is commonly referred to as bloat or GDV (gastric dilatation-volvulus). While the causes of bloat are not fully understood, it is seen more often in deep chested dogs (but can happen to any breed of dog). Initially the stomach dilates with gas and then it can twist on its axis causing reduced blood flow to the stomach and spleen. Twisting of the stomach can be fatal to the dog if not caught in time and some dogs do not survive GDV even with rapid surgical intervention to un-twist the stomach. The procedure of tacking the stomach to the abdominal wall helps prevent the twisting motion and allows time to seek medical care if bloat occurs. 

In the past, gastropexy had to be performed by making a large incision into the abdomen to locate and suture the stomach to the body wall. Fortunately, Animal Hospital of North Asheville has laparoscopes and two surgeons who have laparoscopic training and years of experience which enables us to perform the gastropexy through two small incisions. We use the laparoscopic camera to locate the stomach and bring it up to a second small opening in the body wall. We then suture the stomach to the body wall with dissolving suture material. By the time the suture dissolves, the stomach has adhered to the body wall and is permanently prevented from twisting. Following a laparoscopic gastropexy, the pet only has two small very small incisions that quickly heal with much less discomfort than a large abdominal incision.

Nikko’s family wanted Nikko to have as little discomfort as possible following surgery and were eager to get him home from the hospital as quickly as possible, so laparoscopic gastropexy was a great choice. A few of the advantages of having any procedure done laparoscopically are shorter anesthesia time, reduced incision size, less discomfort/ pain, and most important to Nikko, being able to go home quickly to be with his family.

Nikko’s surgery day began with an early morning appointment for him and his family with Dr. Duncan, so that Dr. Duncan could fully examine Nikko just prior to anesthesia, and Nikko’s family could fully understand the procedures. Of course, Nikko loved the attention from Dr. Duncan’s Exam Room Assistant, Dot, too. Nikko thought everyone was very nice that morning, but he was surprised that no one offered the treats he usually gets when he comes for a visit. The instructions before anesthesia allowed no food that morning, so all he received was petting and hugs. Nikko was given some pre-anesthetic medications that were tailored to his individual needs, and which made him calm and a little sleepy. About twenty minutes later when he was feeling the effects of the pre-anesthetic drugs, an IV catheter was placed in his foreleg and general anesthesia was administered. General anesthesia consists of an injection of a quick-acting anesthetic drug, placement of a breathing tube in his trachea to administer oxygen and gas anesthesia, and lots of supportive care such as warm IV fluids, six parameter monitoring, warm blankets and warming devices as well as a certified veterinary technician continuously by his side. Once he was under general anesthesia and his surgical sites had been clipped and prepped by his surgery technician, he was wheeled into surgery. Although Nikko never saw it, there was some amazing equipment in the room.

The equipment is organized and housed in a rolling cabinet termed a tower. The surgeon, aided by an assistant (both wearing sterile caps, gowns, masks and gloves) makes a small hole into the abdomen and a small port is inserted. A foot-long narrow tube with a fantastic color camera and fiber optics is inserted. The camera is wired to a digital processor and then to a medical grade color monitor, and the fiber optics connect to a variable intensity light source with a xenon light. This system is so detailed that the picture is described as a view “better than the naked eye.” The entire abdomen is bright and can be visualized, but in this surgery, the stomach and the abdominal wall are the areas of interest. The exact location for the second entry point is determined, and second port is inserted. A long slender Babcock  forcep is guided to the part of the stomach to be attached to the abdominal wall. The stomach is gently grasped and pulled up to the second hole, which will become the attachment site. The port is removed and the stomach is attached to the abdominal wall with absorbable sutures. All this is done while being visualized on the screen by the surgeon. The camera, instruments, and the other port are removed and the two small entry holes are closed with a few sutures. Because everything is viewed on the screen, laparoscopic procedures are performed in a dimly lit room. It is amazing to be there with the fiber-optic light delivery cable glowing and the anesthesia monitors displaying EKG, oxygen levels, blood pressure, body temperature and respiration rate shining, while a procedure that previously took an hour or longer to perform is performed in minutes. Laparoscopes can be used for many different procedures and the time, safety, comfort and recovery benefits are wonderful for the patients. 

After Dr. Duncan finished his procedures, Nikko was up, wagging his tail within minutes and ready to be discharged shortly thereafter, eager to return to his beloved home. We were all very happy to hear how great Nikko has done at home after surgery. In fact, we hear he has taken on a new job of supportive caregiver for his mom’s elderly mother. He is such a great boy!

Here’s what his mom has to say about Nikko’s important new duties:

Nikko does not realize he is not the tiny lapdog he once was and insists on lap sitting still. He gets great comfort out of his teddy bear and great joy in his new job...He has decided that he is the caretaker of his "great-grandmother". He checks on her to wake her in AM, sits by her chair in daytime, and checks her before going upstairs to bed at night. This pleases her so much! She is his treat giver each time he goes out to the bathroom. He runs to her chair as soon as he comes in for a Big or Little treat....depending:)...a "Poop-Peroni" .aka Pup-Peroni..or a milk bone for his good behavior.

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