Bella is a 7 month old, female intact Great Dane. She is generally healthy and rambunctious. She presents today for an ovariohysterectomy (spay) and preventative gastropexy. On physical examination her vitals are all normal, she is very excited, and she appears generally healthy. Her deciduous teeth have all fallen out. She is judged to be a good candidate for surgery. Bella is anesthetized and you take her to surgery according to plan.

Little Bella, about 3 months old.

Little Bella, about 3 months old.

 

Many dogs are spayed at about 6 months of age. This age is often chosen as most breeds are approaching adult size, which makes surgery technically easier, and the body is maturing which makes anesthesia a bit safer and more predictable. We often do other minor procedures at the same time such as removing retained baby teeth and microchip implantation. This is convenient as the patient is already anesthetized. On occasion, other preventive procedures are also performed.

Bella is a Great Dane. This is a giant breed of dog with some significant health considerations. Problems like hip dysplasia, hypoadrenocorticism, heart disease and bloat/GDV are major concerns. Approximately 37% of Great Danes are expected to develop GDV in their lifetime. Predisposing factors for GDV are large breed, deep chested, slender dogs, although any breed and any age can be affected. Rounding out the top 5 breeds for GDV are Weimaraners, St. Bernards, Gordon Setters and Iris setters.

this is an x-ray of a St. Bernard with a GDV. The overlapping black round structure in the middle of the x-ray is the stomach. In this picture we can also see part of the chest with a large black tube near the spine. This is a gas dilated esophagus.

this is an x-ray of a St. Bernard with a GDV. The overlapping black round structure in the middle of the x-ray is the stomach. In this picture we can also see part of the chest with a large black tube near the spine. This is a gas dilated esophagus.

When we speak about “bloat” we are really talking about 2 different problems with similar symptoms and consequences but different treatments. A “simple bloat” occurs when the stomach becomes extremely over distended with air. A “GDV” or gastric dilatation and volvulus occurs when this distended stomach rotates on its long axis and effectively occludes both the inlet (esophagus) and outlet (small intestines) of the stomach so nothing can leave the stomach. The result is a stomach of rapidly increasing size. Both problems are incredibly painful, cause severe shock, have a rapid onset and will result in death in a matter of hours if left untreated.

A simple bloat is a medical emergency. Treatment is aimed at removing the gas from the stomach and supporting the patient. A GDV is a surgical emergency. Treatment is aimed at removing the gas from the stomach, returning the stomach to its normal position, preventing it from being able to rotate again, and supporting the patient as needed. Risks are high for GDV surgery as this is a very critical patient. Mortality rates even with treatment are likely between 10 and 33%.

This is an x-ray of a normal golden retriever, actually my dog. The abdomen is normal except for the square foam block in her stomach. Note how small the black area is around the block. This is a normal small stomach. 

This is an x-ray of a normal golden retriever, actually my dog. The abdomen is normal except for the square foam block in her stomach. Note how small the black area is around the block. This is a normal small stomach. 

With Bella, the goal is to prevent the stomach from developing the volvulus (twisting). This is accomplished by performing the gastropexy in an elective manner on a healthy and stable patient. There are a couple of different procedures that can be done but essentially an incision is made into the stomach wall and the muscle of the body wall and these incisions are sutured together.

Once this strong scar heals, the stomach will not be able to move out of position. It is important to remember that the procedure will not prevent a simple bloat, only the volvulus. If a bloat occurs, the problem will be medical and not surgical. This becomes less risky and less expensive to treat.

Bella does well with anesthesia and surgery. Due to the 2 abdominal procedures in different parts of the abdomen she has a very long incision. Healing time is expected to be the same as for a routine spay because the wound will heal from side to side, not end to end. Bella has a normal recovery and is discharged to the owner later in the afternoon. She can have a small meal later in the evening.  

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