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Incisional gastropexy is performed as follows(Figure 8.9):

1 The pyloric antrum is identified (Figure 8.9a).

2 A 5‐cm seromuscular incision is made longitudinally in the pyloric antrum (Figure 8.9b). The incision should penetrate the serosa and muscle layers, leaving the submucosa intact. If the submucosa is inadvertently incised, it should be closed with a simple interrupted or continuous suture pattern before continuing with the gastropexy.

3 A corresponding incision is made through the peritoneum and transverse abdominal muscle on the right body wall (Figure 8.9c). The incision is made in a ventrodorsal direction approximately 3–4 cm caudal to the last rib. The incision should be approximately one‐third of the distance from the ventral to dorsal midline to allow the pylorus to sit in a normal position once the gastropexy has been performed and the abdomen has been closed. The pylorus should be manually opposed to the body wall, prior to making the incision, to gauge the appropriate site.

4 The edges of the gastric wall incision are sutured to the edges of the body wall incision with two simple continuous sutures using an appropriate synthetic absorbable suture material (e.g., 2‐0 polydioxanone). The first suture is started dorsally at the cranial borders of the gastric wall and body wall incisions (Figure 8.9d), and these borders are then apposed (Figure 8.9e). A second suture is started dorsally at the caudal border of the gastric wall and body wall incisions (Figure 8.9f), and these borders are then apposed, completing the gastropexy (Figure 8.9g).

Although recurrence has been reported following incisional gastropexy, the rate has been generally considered to be minimal [68, 70]. Two more recent studies found a 0% recurrence rate of GDV following incisional gastropexy in cohorts of 34 and 40 dogs [71, 72]. However, subsequent gastric dilatation occurred in 5.0% and 8.8%, respectively. A variation on the incisional gastropexy technique is described in 20 dogs, using a GIA™ (Covidien) stapler [73]. A seromucosal tunnel is made in the pyloric antrum and stapled to a corresponding tunnel in the body wall. This technique is quick to perform, although there is an increased cost associated with the stapler. This technique was associated with 0% recurrence in this study [73].

Figure 8.9 Series of intraoperative images showing the technique for incisional gastropexy. (a) Position of gastric incision in the pyloric antrum noted by DeBakey forceps. (b) Seromuscular incision in the pyloric antrum. (c) Incision in the body wall through the peritoneum and transverse abdominal muscle. (d) Placement of the first suture dorsally on the cranial border of the incisions. (e) Simple continuous suture apposing the cranial borders of both incisions. (f) Another suture has been placed dorsally at the caudal border of the incisions. (g) The finished gastropexy. Ca, caudal; Cr, cranial.