Gastric dilation and torsion, or bloat in dogs and laparoscopic gastropexy – a preventative surgical procedure

Gastric dilation-volvulus (GDV) syndrome is a painful and life-threatening condition in which the stomach becomes hugely distended with gas and fluid and rotates on its axis, often through 1800 to 3600. Gross gastric dilation can occur without rotation of the stomach.

Any breed of dog may be affected but large and giant breeds are predisposed – Great Danes, German Shepherds, Gordon and Irish Setters, Bassett Hounds, Airedales, Wolfhounds, Weimeraners and Rottweilers to name a few. A study found that 18% of all Great Dane deaths were due to GDV (Evans and Adams 2010). The specific cause is unknown but several risk factors beyond breed have been identified (Glickman 2000); a high ratio between chest height and chest width (deep-chested individuals), increasing age, having a first-degree relative affected, speed of eating, using an elevated food bowl. Other factors affecting incidence include male gender, low body weight, eating one meal per day and a fearful or anxious temperament.

Dogs may present following a period of restless behaviour, non-productive retching and hypersalivation. They will have a dramatic and progressing distension of their abdomen. They may be pale, with a rapid heart rate, breathing difficulties and may be collapsed.

Stretching of the stomach wall, and twisting, compromises the blood flow to the wall, reducing oxygen supply which can lead to death of the tissue. The spleen, which is attached to the stomach, can undergo twisting or torsion as well, leading to similar effects. The dilated stomach compresses the vena cava. Compression of this vein reduces the return of blood to the heart from the abdomen and hind legs of the dog. The dilated stomach presses on the diaphragm reducing its movement and consequently the ability for the lungs to expand normally. The circulatory and respiratory effects lead to a reduced supply of blood and oxygen to tissues, resulting in shock and if untreated eventually death.

Treatment includes aggressive intensive care and fluid therapy to combat the fatal effects of shock, decompression and if necessary, de-rotation of the stomach. In some cases, removal of the spleen (splenectomy) or resection of part of the stomach (partial gastrectomy) is required. Even with prompt treatment mortality rates can be high – published results range from 10% (Brockman 1995) to 33% mortality (Mackenzie 2010). The prognosis is better where there is dilation but no twisting (Brockman 1995). However, where gastrectomy and splenectomy are required the mortality rate has been reported as high as 55% (Brourman 1996).

The incidence of gastric dilation and volvulus can be influenced by selective breeding and management of feeding – avoid stress at mealtimes, feed more than once per day, do not feed from a height, slow down rate of eating. A gastropexy is a surgical procedure where a permanent adhesion is created between the stomach and the body wall. It is performed for the prevention of a gastric dilation and volvulus (GDV) either in animals suffering from an episode of GDV or as a preventative procedure. Dogs treated for GDV with de-rotation of the stomach but no gastropexy had a recurrence rate of 50%, whilst those treated with a gastropexy had a rate of less than 5% (Glickman 1997). A study of five predisposed breeds (Great Danes, Irish Setters, Rottweilers, Standard Poodles and Weimeraners). Ward, M.P (2003) found a reduced lifetime risk of mortality ranging from 2.2-fold in Rottweilers to 29.6-fold in Great Danes.

There are several different open abdominal techniques to achieve a gastropexy, however these require significant exposure of the abdomen to achieve the result. There are also laparoscopic-assisted procedures where the surgeon uses a telescope and camera to identify and grasp the stomach before suturing to a reduced abdominal incision up to 6cm long. However, the gold standard procedure is to perform the procedure entirely laparoscopically. While this technique requires significantly more skill and experience on the part of the surgeon, in such hands the comfort of the patient and recovery rate are much enhanced.

Laparoscopic gastropexy should be considered in at risk breeds. The procedure can be performed as a single procedure in male dogs or at the time of ovariectomy ovariohysterectomy in females.

  1. Brockman, J.D., Washabau, R.J., Drobatz, K.J., (1995) Canine gastric dilation-volvulus syndrome in a veterinary critical care unit: 295 cases (1986-1992) Journal of the American Veterinary Medical Association 207: 460-464
  2. Brourman, J.D., Schertel, E.R., Allen, D.A. et al (1996) Factors associated with perioperative mortality in dogs with surgically managed gastric dilatation-volvulus: 137 cases (1988-1993) Journal of the American Veterinary Medical Association 208: 1855-1858
  3. Evans, K.M., Adams, V.J. (2010) Mortality and morbidity due to gastric dilation-volvulus syndrome in pedigree dogs in the UK. Journal of Small Animal Practice 51: 376-381
  4. Glickman, L.T., Glickman, N.W., Schellenberg, D.B., Raghavan, M., Lee, T.L. (2000a) Incidence of and breed-related risk factors for gastric dilatation-volvulus in dogs. Journal of the American Veterinary Medical Association 216: 40-45
  5. Glickman, L.T., Glickman, N.W., Schellenberg, D.B., Raghavan, M., Lee, T.L. (2000b) Non dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs. Journal of the American Veterinary Medical Association 217: 1492-1499
  6. Mackenzie, G., Barnhart, M., Kennedy, S. et al (2010) A retrospective study of factors influencing survival following surgery for gastric dilatation-volvulus syndrome in 306 dogs. Journal of the American Animal Hospital Association 46: 97-102
  7. Ward, M.P., Patronek, G.J., Glickman, L.L. (2003) Benefits of prophylactic gastropexy for dogs at risk of gastric dilation-volvulus. Prev Vet Med 60: 319-329

Spaying female dogs? Why? What? How?

Recently a lovely lady with a super young female dog appeared in my consult room wanting to know about laparoscopic spaying or neutering. She was a client at another practice but her vet, a friend of mine, had suggested she seek us out! It was great to speak to someone who had done a lot of research herself so I thought I’d write an article based around that conversation.

It has long been accepted that we should consider spaying or neutering female dogs. However, as it is a choice that we, as pet owners have to make, we should ask ourselves what the reasons for this are. Population control, avoidance of unwanted pregnancies is an obvious reason. Social reasons, the prevention of signs of a bitch coming in to heat – vaginal bleeding or being chased around the park by overly enthusiastic male dogs – again is straightforward. There are health benefits to your bitch which for some reason, we often forget about. The Royal Veterinary College (RVC) in London have a detailed disease surveillance programme, involving many veterinary practices and hence literally thousands of dogs. One of the simplest statistics to come from this is simply that neutered dogs live longer than entire or un-neutered ones. In the female dog we prevent ovarian and uterine cancers. Mature bitches who have never bred or who haven’t had a litter for many years can commonly develop a serious and potentially life-threatening womb infection, called a pyometra. Pyometra can be treated surgically but surely this is best prevented. If a bitch is spayed earlier in her life there is a dramatic reduction in the incidence of mammary carcinomas (breast cancer) in her later years. We see this in practice – many years ago, surgery for mammary tumours was frequently performed in the surgery, but now, with the majority of older females being spayed, we perform significantly fewer procedures. So we can argue that spaying your female dog is an important part of preventative health care.

So, we have decided to neuter our lovely female dog. What does this actually entail?

The traditional spay performed in the U.K. would be an ‘open’ surgical procedure. This means that the surgeon creates a wound in the abdomen, large enough to allow direct access for the fingers, hands and surgical instruments to the contents of the abdomen. The operation would usually involve the removal of both ovaries and the uterus. This is called an ovariohysterectomy (OVH). The alternative surgery involves the removal of only the ovaries (an ovariectomy or OVE). Surgical procedures can involve complications, however rare, and studies have shown no difference between OVH and OVE regarding the incidence of womb infections or incontinence.

Now we know just a little about what the neutering surgery entails do we have any other considerations? Well, yes!

Nowadays the choices available are further broadened by the development of Minimally Invasive Surgery (MIS) or laparoscopic assisted surgical techniques, sometimes called ‘keyhole surgery’. The range of surgeries we can perform laparoscopically mirrors that of human surgical practice. Neutering a female dog and removing retained abdominal testicles (which have a high risk of undergoing cancerous change) in a male dog, are surgeries that lend themselves to MIS. Rather than completely opening the body cavity we place surgical tubes (or cannula) between 5.5mm and 10mm in diameter through the abdominal wall to gain surgical access, using special scissors, forceps and sealing devices. The patient’s abdomen in inflated with carbon dioxide gas to create a space in which to perform the surgery. The whole procedure is viewed via a digital camera on a high definition monitor.

Is laparoscopic surgery better than open surgery? This is a question I am often asked. There is nothing wrong with traditional open surgery. It is safe and surgeons are well practiced with techniques and in fact when performing an MIS laparoscopic procedure we are always prepared to convert to an open procedure. What else could we do if our camera broke? However many studies in both the human field and Veterinary surgery have demonstrated lower complication rates with wound infection or haemorrhage, lower pain levels and a more rapid return to normal activity. A study in 2009 showed that female dogs undergoing OVH via an open procedure were 62% less active in the 24 hours after surgery, while those undergoing OVH laparoscopically were only 25% less active. Typically our patients are exercising normally a week after surgery.

Are there any disadvantages to laparoscopic surgery? Learning laparoscopic surgery has a steep learning curve but as with all things with experience the procedure become straight forward. The procedure is more expensive performed laparoscopically because of the high cost of equipment and the extensive training required. However for reasons of reduced post operative pain and a much reduced return to normal activity, laparoscopic surgery offers a good alternative to traditional open surgical neutering.

Dugie Gemmill is the Clinical Director, and principal surgeon in his own Veterinary practice on the Wirral, with an interest in laparoscopic surgery and orthopaedics. He has been performing laparoscopic surgery for over eight years and as well as offering the procedures in his own practice, also operates at certain practices in North Wales.

Dog Blood Transfusion and Donation

Very recently here at Parkside we found ourselves trying to save an increasingly critical patient. A lovely black Labrador bitch developed a disease called immune mediated haemolytic anaemia – her own immune system no longer recognized her red blood cells and was producing antibodies to destroy them. A normal red blood cell count or PCV in a dog is between 37% and 61%. Bess’s PCV had fallen to 18% in twenty four hours. We faced a terrible clinical dilemma as she urgently required a blood transfusion.

In 2007 thewp_20150607_001 Pet Blood Bank came into being in the UK, a not-for-profit organization supplying blood products within the UK for veterinary use. In 2013 the Pet Blood Bank supplied over 3000 units of blood products to the UK veterinary profession.

To be concise, the presence of this organization saved Bess’ life! Within four hours of contacting the PBB we had three units of packed red blood cells ready for her.The transfusion in combination with round the clock care from our dedicated nursing team saved lovely Bess.

As with human blood transfusions, blood comes in different types. It is important to match donated blood with the recipient’s blood type to reduce the risk of transfusion reactions, which can be life threatening. Canine blood types are described as ‘dog erythrocyte antigens’ (DEA) and there are eight DEA systems in the dog; 1.1, 3, 4, 5, 6, 7 and 8. DEA 1.1 is regarded as the most significant in relation to serious transfusion reactions. There are commercial blood type test kits for DEA 1.1 which means that practicing vets can easily ascertain a patient’s type.

Dogs are either DEA 1.1 positive where the 1.1 antigen is present or DEA 1.1 negative where it is not. The Pet Blood Bank reports that 70% of dogs are DEA 1.1 positive. It is important to realise this for two reasons. Firstly the supply of DEA 1.1 negative blood is more limited as there are fewer donors. Secondly, as DEA 1.1 negative blood can be given to positive recipients we must minimise this to preserve the available stocks of the rarer type. Blood typing in the veterinary practice is very important. It also appears that certain breeds have a higher probability of being DEA 1.1 negative.

Packed red blood cells can be stored for up to 42 days at 4oC +/- 2oC, but it can be easily deduced that blood donors are as important to the veterinary and pet owning worlds as they are to human medicine. The Pet Blood Bank uses a network of volunteer practices as donation centres, using their facilities to collect blood from blood donor dogs.

Certain breeds appear to have a predisposition to being DEA 1.1 Negative blood. These are listed below. As there is a higher demand for DEA 1.1 Negative blood, the PBB tries to encourage more donor owners with these breeds to register their dog onto a blood donation programme. These breed are;

Airedales                                                              parkside-final-logos-dog-alone

American Bulldog



English Bull Terriers

Flat Coated Retrievers

German Shepherdspet-blood-blank-logo



Mastiffs various breeds

Pointer (English)


Just as in human blood donation, there are certain criteria that a dog must meet to enable safe blood donation.

The dog must:

1. Be aged between 1 and 8 years

2. Weigh over 25kgs – 55lbs lean bodyweight

3. Be in good general health

4. Be up to date with vaccinations – dogs cannot give blood up to 14 days after their annual booster vaccination

5. Not be taking certain medications – see exclusions information

6. Have no history of heart murmur, seizures or fainting episodes

7. Have no history of travel abroad

8. Have not received a blood transfusion

9. Have a good temperament and be able to lie quietly for a tummy rub for 5-10 minutes while blood is donated. Click here to see a video of a donor giving blood.

Is your home environment safe for your dog?

Dog and poisonsA surprising number of things in your home may cause problems for your dog. Here we discuss just a few of them, but more information can be found online. See the reference at the end of the article.

The commonest one is when your dog takes in medicines intended for humans. Drugs that might be beneficial or even lifesaving for people can have the opposite effect in dogs. And it doesn’t always take a large dose to do major damage. One of the most dangerous human drugs for dogs is the pain killing drug, Ibuprofen, found in many over-the-counter preparations.  We are used to taking this drug for our aches and pains but dogs are really sensitive to the drug and can rapidly develop ulcers in the stomach, which may prove fatal! Never give your dog human medicines.

We are all fond of chocolate but it is not good for your dog. Chocolate is derived from the roasted seeds of Theobroma cacao, which contains substances that can be toxic to dogs especially caffeine and theobromine. If ingested, these two ingredients can cause vomiting, diarrhoea, heart problems or even fits.

  • Milk Chocolate is the least dangerous although mild signs of toxicity can occur when 0.7 ounces per pound of body weight is ingested; severe toxicity will occur when two ounces per pound of body weight is eaten (or as little as one pound of milk chocolate for a 20-pound dog).
  • Dark chocolate is more likely to cause problems especially when it contains over 80% chocolate. Mild signs of toxicity can occur when 0.3 ounce per pound of body weight is ingested. Severe toxicity occurs when one ounce per pound of body weight is eaten (or as little as six ounces of dark chocolate for a 20-pound dog).
  • Baking Chocolate and cocoa powder are the most dangerous although these are usually taken in as a result of scavenging rather than being offered to the dog. As little as two small one-ounce squares of baking chocolate can be toxic to a 20-pound dog (or 0.1 ounce per pound of body weight).

Other common foods that are surprisingly toxic to dogs are grapes and raisins. Although the exact substance that causes a toxic reaction is not known, dogs should not eat grapes and raisins because even small amounts can be fatally toxic for a dog. Dogs of any age, breed, or gender may be affected as the toxin causes acute (sudden onset) kidney failure. Kidney failure is not seen in all dogs after ingestion of grapes or raisins, and the reason why some dogs are affected while others are not is still being studied. The initial clinical signs are vomiting and/or diarrhoea, often within a few hours. Around 24 hours after ingestion, vomit and faecal contents may contain pieces of grapes or raisin.

Apart from grapes, a surprising number of human foods can cause problems including avocados. They contain a substance called persin that can cause vomiting and diarrhoea. Even macadamia nuts can be toxic. Xylitol is a sweetener found in many “sugar free” products that can cause problems in dogs including a rapid drop in blood sugar or even seizures.

Antifreeze is another common form of poisoning in dogs. Dog will readily lick the antifreeze dripping from a car’s radiator or from spillage when changing the radiator coolant fluid. It is the toxin, ethylene glycol that makes antifreeze lethal. Dogs will consume significant quantities of ethylene glycol before being repulsed by its aftertaste. By then, it is too late. It doesn’t take a significant amount of ethylene glycol to cause fatal damage to the system and kidney failure; less than three ounces (or 88 ml) of antifreeze is sufficient to poison a medium-sized dog. Antifreeze poisoning affects the brain, liver, and kidneys.

So beware, our environment is not as safe and cosy as we might believe!

Common Pet Poisons

How can I help my dog cope with Bonfire Night?


Guy Fawkes Night approaches and we have already had some clients asking for tablets and advice for their frightened dogs!
Currently we suggest a three pronged approach……
1) Dog Appeasing Pheromone plug-in diffuser
2) Therapy eg. Xanax (Alprazolam) tablets, an anti anxiety medication. It has also been shown to help block memories of traumatic events, so is particularly useful in this instance.
3) Set up a “safe room” or safe hiding place for your dog.

How to create a “safe hiding place”

Several clients have already found this advice useful.

Typically, dogs prefer to hide in a dark, quiet place, away from household activity, but they may also want to be close to a person for added security. Following this procedure may help improve a hiding place……

  • Windows and curtains closed, with lighting dimmed.
  • A comfortable, familiar bed with extra blankets and items of recently worn clothing carrying the scent of the owner.
  • A water bowl, chews and toys nearby in the room.
  • A Dog Appeasing Pheromone diffuser in the room where the hiding place is, close to where the dog’s bed is located.

Your dog is more likely to use a hiding place if he or she likes to go there at other times. If possible, the hiding place should be set up a week ahead of any loud noise events.

You should give your dog treats and chews when it is in the hiding place, and show attention and approval when you find them there. This allows time for your dog to get used to the hiding place and associate it with pleasant experiences. The hiding place must be available to your dog at all times, regardless of whether or not you are at home.