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The initial aim of surgery is to decompress and reposition the stomach. This will help to address continuing hypoperfusion caused by the distended stomach and allow subsequent assessment of tissue viability and a gastropexy to be performed.

Typically, the stomach is twisted between 90 and 360 degrees in a clockwise direction [46]. The direction of torsion is assessed intraoperatively from the caudal aspect of the dog in dorsal recumbency. For a clockwise torsion, the pylorus of the stomach moves ventrally and toward the left side of the abdomen. Owing to the direction of this movement, the stomach enters the omental bursa and is therefore covered by a single layer of omentum (Figure 8.7a).

Repositioning can be facilitated by further gastric decompression. An assistant passes an orogastric tube and the surgeon should be able to manually guide the tube through the cardiac sphincter. If this is not possible, needle gastrocentesis can be performed to reduce the distension. Repeated gastric lavage with warm tap water via the orogastric tube can help to decompress the stomach further. If there is a large amount of food present in the stomach, a gastrotomy may be necessary to allow repositioning.

To derotate a clockwise rotated stomach, the surgeon stands on the right‐hand side of the dog and uses their right hand to grasp the pylorus of the stomach, lying in the cranial aspect of the abdomen on the left‐hand side. The pylorus is then gently retracted ventrally and toward the right‐hand side of the abdomen. At the same time, the surgeon should exert downward pressure with the left hand on the visible portion of the stomach, encouraging it to move dorsally (Figure 8.7b). This movement may need to be performed several times to fully derotate the stomach.

Figure 8.7 Series of intraoperative images showing derotation of the stomach at exploratory laparotomy in a dog with gastric dilatation and volvulus. (a) Initial appearance of the dilated stomach. The stomach is covered by omentum, which is indicative of a clockwise torsion. (b) Appearance of the stomach during derotation. The pylorus (P) is identified. (c) The dilated stomach, which has been restored to a normal position.

Once the stomach has returned to a normal position (Figure 8.7c), further decompression and lavage can be performed using the orogastric tube. If a gastric foreign body is present, a gastrotomy may be necessary.