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An appropriate gastropexy is a vital part of treatment for GDV, forming a permanent adhesion between the stomach and the body wall to prevent recurrence. Since the pylorus is the most mobile part of the stomach, the gastropexy should be between the pylorus and the right body wall.

In a prospective study, the median survival time was significantly greater for dogs treated with surgical decompression and gastropexy compared to those treated with surgical decompression without gastropexy, with a recurrence rate of 4.3% compared with 54.5% [51]. In the same study, the mortality rate for dogs that did not have a gastropexy performed and suffered recurrence was 83.3%. In another study, dogs treated with surgical decompression without gastropexy had a 50% recurrence rate at six months, which was significantly greater than the 0% recurrence rate for dogs treated with surgical decompression and circumcostal gastropexy [56]. The mortality rate within the first year was also significantly greater for the dogs that did not receive a gastropexy.

Gastropexy techniques include incisional, belt‐loop, circumcostal, tube, incorporating and gastrocolopexy [45,57–63]. Other techniques are described for prophylactic gastropexy including endoscopy assisted and laparoscopic, although these are not useful in the emergency situation [64, 65].

Evidence to support recommending one technique over another is weak, with few studies objectively comparing techniques in a clinical setting. In a study comparing the tensile strength of a number of techniques, circumcostal gastropexy had the greatest strength to failure [66]. The strength necessary to prevent recurrence of GDV is unknown. Studies have shown that incisional, belt‐loop, circumcostal and tube gastropexy all form permanent adhesions as assessed at postmortem or using laparoscopy or ultrasound [60–62, 65,67–69]. In most circumstances, the authors recommend an incisional or belt‐loop gastropexy, as these techniques are easy to perform and create a permanent adhesion.