click for Virginia-Maryland Regional College of Veterinary MedicineProphylactic Laparoscopic Gastropexy
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Virginia-Maryland Regional College of Veterinary Medicine
Introduction
Scheduling the Visit

Surgery
Post Surgery
Lessons Learned

References
The most important fact to know about Great Danes is that they are the #1 breed to die from gastric volvulus and dilation (GDV), also called "bloat."  GDV happens to almost half of them despite diligent ownership. 

GDV is a Dane owner's worst nightmare and I speak from experience. In July 2006, we almost lost our sweet Great Dane girl Merlot when she suffered from GDV and had traditional gastropexy. That experience was a wake-up call to have prophylactic (preventative) gastropexy to prevent GDV in our other Danes. 

Most veterinarians offer traditional gastropexy, but there are newer laparoscopic (minimal incision) approaches. In general, laparoscopy is less painful for the dog, has a lower infection rate and faster recovery. I discussed "Lapro-Pexy" with our veterinarian Dr. Steven Wolchinsky who was very supportive. After  Merlot's post-operative issues and long recovery period, I opted for the laparoscopic approach. 

There are very few vets in our area that offer Lapro-Pexy, and it is very expensive.  I'd also heard distressing reports from Lapro-Pexy consumers about poorly calibrated equipment

    and inconsistent results. It made sense to take our Danes to the place where this procedure is taught -- a  Veterinary Teaching Hospital (VTH.) 

The Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM) teaches laparoscopy and was recommended by Dr. Wolchinsky.  Although I'd heard positive reports about this VTH, it is in Blacksburg, VA -- a long 6 hour trip for both Danes and driver.

I went to the VMRCVM web site and read about their  faculty and specialists awards and grants from USDA, NIH and CDC. I learned that only top senior surgical students perform surgeries under the direct supervision of faculty. Clearly, VMRCVM was a hospital that I could trust with our fur family.

I decided it would be well worth the long drive. At age 8-1/2, our Dane Kuna was too senior to risk anesthesia and surgery, but 6 year old Jupiter and 8 month old Savannah were  candidates. 

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Before calling to schedule, I reviewed the Dane surgical recommendations to learn about anesthesia and requisite pre-surgical tests for this breed.  There are also various approaches to gastropexy, but the same techniques may be used with either traditional or laparoscopy. Laparoscopic procedures typically take a little longer, so it is critical to know what anesthesia should be used.

I called VMRCVM a month in advance to ask questions about the procedure and to schedule the Lapro-Pexy appointment for Jupiter and Savannah.  Dr.  Wolchinsky completed and faxed the referral form to the hospital.       

 

VMRCVM reception team

 

VMRCVM is on the campus of Virginia Polytechnic Institute (VPI)  in the foothills of southwestern Virginia.  Although it was a long drive, it was uneventful. Jupiter and Savannah slept most of the way.  I booked a hotel in Christianburg, VA, a mile from the hospital.  The town is full of shopping centers and restaurants, and lots of things to do while I waited the two days for Jupiter and Savannah to have surgery.

I can't say enough about the compassionate staff at VMRCVM -- everyone from the receptionists, to the faculty, to the senior surgical students are obviously animal lovers.  There were photos of people's personal pets throughout the facility.  <top>

Jupiter and Savannah had their intake exam with Resident Dr. Farrah Horowitz (DVM, Surgery) and Faculty Member Dr. Don Waldron (DVM, DACVS/DABVP, Surgery.)  Senior surgical student Rebecca Greene was assigned to care for Jupiter;  senior surgical student Elizabeth Sochurek was assigned to Savannah.  Both students and faculty members did complete physical exams on both Danes.  Savannah was in optimum health and at 8 MO she weighed 94.5 lbs. 

During Jupiter's exam, they noticed that he had an irregular heartbeat and a lump on his lower rib cage. Both were cause for concern.

Then both Danes were taken away to begin tests and prep for surgery the next day.  A pre-operative echocardiogram (ECG) was performed on Jupiter and the results were evaluated by VMRCVM's cardiology specialist. He found that  although Jupiter has some mitral valve insufficiency, as of now there is no dialated

  Jupiter and Savannah with Mom during intake exam
cardiomyopathy (DCM.) He recommended an annual re-test to enable early detection and treatment should DCM develop.  
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Rebecca with Savannah; Elizabeth with Jupiter

 

It was a very, very long two days to suffer through fur family withdrawal!  During this time Jupiter and Savannah underwent health testing, incisional technique gastropexy, and post-operative care.  They aspirated Jupiter's lump and found that it was benign. There were no complications with any of the surgeries.

Since Jupiter is a senior at age 6 years old, after surgery they placed him in intensive care as a precaution.  Post surgery, Jupiter had two tiny abdominal slits, plus one 2" incision on his lower chest.  He is sore, but recovering well.

Savannah had the same incisions.  When I saw them the day after surgery, silly puppy girl was bouncy and playful -- you'd never know she'd just had major surgery.

The photo above was taken less than a day after surgery. Savannah and Jupiter are shown here with senior surgical students Rebecca Greene and Elizabeth Sochurek. 

There was a HUGE  difference between Jupiter and Savannah's post-surgical condition and Merlot's after she bloated.  Five days after her near-death experience, Merlot had a foot-long incision and still could not stand up on her own. But as you can see from the photo above, less than 24 hours after surgery Savannah and Jupiter look bright and chipper!  <top>

 

One thing really impressed me about both the doctors and the students at VMRCVM.  Despite treating dogs of all breeds, they were very familiar with Great Dane health issues. Of course they knew about GDV, but they also knew about the prevalence of DCM in the breed.  They knew to aspirate and test Jupiter's lump for cancer, but knew enough to ignore his skin tags.  Most of all, unlike with smaller breeds, they knew that at age 6, Jupiter is considered a senior Dane. He was given specialized tests, after-care, and meds. <top> 
 

Lessons learned from this experience:
bullet First and foremost, I could never live with myself if we lost a canine family member due to my failure to get them a life-saving surgery.
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I will never again wait until a Dane is a senior before considering prophylactic  gastropexy.  The difference in the post-surgical condition of puppy Savannah versus senior Jupiter was remarkable.  

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I will never again put my Danes at risk waiting for a life-saving procedure to come to a vet near me. I will go to the experts -- no matter where they are. When my Danes need non-emergency surgery in the future, I will take them to a VTH.  Veterinary experts and pioneers in veterinary medicine are all there in one place. Test outcomes can be followed up on-the-spot, and they are more than willing to discuss procedures and answer questions.

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VTHs focus not just on surgery, but also on preventative care -- and it was stellar at VMRCVM. Without me having to ask or make a separate appointment, they investigated two of Jupiter's potential health concerns.  Can't ask for better care!

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When it's an option, laparoscopic surgery is the only way to go.  Done well, there are benefits too numerous to mention here. Suffice to say, two days after surgery you would never know that Jupiter and Savannah had major surgeries. Select the first link below to learn more about the Lapro-Pexy procedure.

 
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Communications at this VTH were also exceptional -- a surprise considering this is a college.  Before and after surgery, I was called several times a day with status updates.  I received a full, two-page detailed report for each dog that included pre/post surgical notes, surgical approach, surgical outcome, home care, and medications. They also included a list of post-surgical conditions that  might warrant a trip to our vet. This is more detail than I have ever received for veterinary services. 

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I knew that laparoscopy equipment is expensive to purchase and maintain. Local vets charge $4,000 -- $5,000 per laparoscopically-assisted surgery to recoup their costs. 

What I didn't know was that Lapro-Pexy performed by experts at a VTH averages $700 - $900. 

It gets even better. Because they don't often have giant breed teaching opportunities, VMRCVM cut $300 off their fee.  The bottom line for two Danes was substantially less than the cost of Merlot's single bloat.

Last thoughts:  Our Danes got expert and compassionate care at low cost. Best of all, I can sleep nights knowing that Lapro-Pexy will help extend the lives of our canine family members. 
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Links with more information on Lapro-Pexy:
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Vet Surgery Central: Minimally Invasive Gastropexy - a Preventative Procedure
[Conclusion:  Shorter surgery and anesthesia time; less pain; quicker recovery; prevents life-threatening twist of stomach; less expensive than treating life-threatening GDV; patient can go home on the day of the procedure]

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AVMA, University of Georgia: A rapid and strong laparoscopic-assisted gastropexy in dogs [Conclusion: The laparoscopic gastropexy technique described in the present study could be performed quickly and easily by an experienced surgeon, resulted in a strong fibrous adhesion between the stomach and abdominal wall, and appeared to cause minimal stress to the dogs. (Am J Vet Res 2001;62:871875)]

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Auburn University: A comparison of laparoscopic and belt-loop gastropexy in dogs
[Conclusion: The results of this study indicate that laparoscopic gastropexy provides a minimally invasive alternative to open abdominal prophylactic gastropexy in dogs]

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World Small Animal Veterinary Association: Gastric Dilatation-Volvulus: Risk Factors and Some New Minimally Invasive Gastropexy Techniques
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Conclusion: Although (gastropexy) can be done by standard "open" laparotomy techniques, laparoscopic or laparoscopic assisted techniques are now being used successfully.

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Laparoscopy Assisted Gastropexy from Lakewood Animal Hospital with photos and description.

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Web page created on 11/11/06 and last updated on 05/09/2009.