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Tube gastropexy is performed as follows (Figure 8.11):

1 A large (24‐ or 26‐gauge) Foley catheter or de Pezzer mushroom tipped catheter is used for the tube. The authors prefer the mushroom tipped catheter in most instances.

2 A stab incision is made in the body wall approximately 3–4 cm lateral to the ventral midline and 3–4 cm caudal to the last rib on the right‐hand side (Figure 8.11a). The tip of the tube is passed through the stab incision into the abdominal cavity with the aid of forceps (Figure 8.11b).

3 The pyloric antrum is identified.

4 A purse‐string suture of an appropriate synthetic absorbable suture material (e.g., 2–0 polydioxanone) is preplaced in the pyloric antrum.

5 A stab incision is made into the stomach through the purse‐string suture and the catheter tip is placed into the lumen (Figure 8.11c).

6 The purse‐string suture is tied tightly around the catheter and. if using a Foley, the bulb is inflated with saline.

7 Four pexy sutures of an appropriate synthetic absorbable suture material (e.g. 2–0 polydioxanone) are preplaced around the gastric and abdominal wall incisions (a box suture; Figure 8.11d). Care is taken to avoid including the end of the catheter in these sutures.

8 The sutures are then tied tightly (Figure 8.11e) and the pexy site is omentalized.

9 The balloon or mushroom tip is drawn up to the stomach wall and the tube secured on the outside of the skin with a Roman sandal suture.

10 An abdominal bandage is placed postoperatively to protect the tube.

11 The gastropexy tube should remain in place for 7–10 days. The tube is removed by traction and the stoma is left to heal by secondary intention.

A tube gastropexy is similar to a standard tube gastrostomy but, importantly, the tube is placed through the right body wall and into the pyloric antrum. This technique has some advantages in certain circumstances, as it allows postoperative decompression if recurrent gastric distension occurs and can be used for enteral feeding. This may be particularly useful in dogs undergoing significant gastric resection or those with chronic gastric dilatation. The main disadvantage is that the tube needs to be maintained for at least seven days and the technique involves a full‐thickness incision into the stomach, with a theoretical risk of peritonitis. The recurrence rate for tube gastropexy is reported as 5–11% [58, 59, 66]. One study reported tube gastropexy with a mushroom tipped catheter in 31 dogs [76]. Three dogs had a major complication including two with premature tube removal due to interference from the dog. One dog died due to septic peritonitis as a result; 30 dogs survived to discharge and there was no recurrence of GDV in 21 dogs with follow‐up at a median of 2.5 years (range 3 months to 5 years).

Figure 8.10 Series of intraoperative images showing the technique for belt‐loop gastropexy. (a) Seromuscular incision (yellow arrow) in the pyloric region to create a flap based on the serosal blood vessels. (b) The flap is undermined, taking care not to penetrate the submucosa (S). A stay suture has been placed in the tip of the flap (yellow arrow). (c) Parallel incisions in the body wall through the peritoneum and transverse abdominal muscle. The tissue between the incisions is undermined to create a tunnel, the “loop.” (d) The flap has been passed caudal to cranial through the loop and sutured back in place with absorbable suture material.

Source: Courtesy of Dan Brockman.