Gastric Surgery

• Indications for gastric surgery

  • Foreign body removal
  • GDV
  • Neoplasia
  • Ulcerative disease
  • Gastric outflow obstruction
• Principles of gastric surgery

  1. Full exploratory

  2. Isolate/ pack off with laparotomy sponges

  3. Stay sutures

  4. Perform planned procedure

  5. Closure

  6. Local lavage

  7. Change to sterile gloves and instruments

  8. Abdominal lavage
• Gastric Foreign Body

  • Often younger animals
  • Pre-operative considerations: CBC/chem, UA, Correction of dehydration, acid-base abnormalities, Radiographs
• Gastrotomy


  1. Full abdominal exploratory- palpate stomach and intestines thoroughly

  2. Pack off abdomen

  3. Stay sutures

  4. Suction ready

  5. Incision on the body

  6. Closure w/ monofilament (PDS): Inner layer (mucosa/submucosa) simple continuous appositional or inverted pattern, Outer layer (muscularis/serosa) inverted patterns

  7. Save FB for client
• Ulcerative disease


  Conditions that disrupt gastric mucosa and overwhelm mucosal protective mechanisms
• Conditions that can cause ulcerative disease

  • Hepatic disease
  • Neoplasia
  • Renal disease
  • NSAIDs/corticosteroids
• Ulcerative disease clinical signs

  • Vomiting (sometimes "coffee grounds"), anorexia, melena
  • Or no clinical signs with anemia
• Ulcerative disease diagnosis

  • Presumptive
  • Gastroscopy confirms diagnosis
• Ulcerative disease medical management


  • Histamine receptor antagonists
  • Proton pump inhibitors
  • Sucralfate
  • Misoprostol
• Ulcerative disease surgical management


  Partial gastrectomy (more in GDV lecture): Secondary to a tumor, Significant bleeding, Impending perforation or perforation has occurred
• Gastric Outflow Obstruction (non FB)


  • Congenital: Pyloric stenosis
  • Acquired: Chronic hypertrophic pyloric gastropathy (CHPG), Neoplasia, Stricture
• Pyloric Stenosis


  • < 1 year old (congenital), Brachycephalics
  • Muscular hypertrophy of the pylorus
  • Projectile vomiting of undigested food after eating: Regurgitation is passive, vomiting is active!!
  • Diagnosis: Contrast radiography/fluoroscopy - Apple core-ing appearance
  • Surgery: Pyloroplasty - General term for widening the pylorus
• Chronic Hypertrophic Pyloric Gastropathy (CHPG)


  • Acquired, middle age to older small breeds (Shih tzus or llasa apsos)
  • Clinical signs/ exam: Chronic intermittent vomiting, Weight loss, dehydration, Large fluid filled stomach
  • Diagnosis: Contrast radiography, fluoroscopy (rule out tumors?)
  • Surgery: Y-U Pyloroplasty
• Pyloroplasty


  • General term for widening the pylorus
  • Indication: Gastric outflow obstruction
  • Techniques: Pyloromyotomy, Transverse pyloroplasty, Y-U Pyloroplasty - usually best choice!!, Pylorectomy and gastroduodenostomy - Considered more often for neoplasia
• Pylorus surgery is a good referral.

  Do not mistake normally turgid pylorus for a stenosis.

  Need definitive dx prior to surgery.