The Fall 1999 Bulletin included an article about prophylactic gastropexy, and I have been asked to go into a little more detail
about the types of gastropexies, as well as the pros and cons of each. Prophylactic gastropexy is a procedure where the
stomach (gastro) is permanently fixed (pexy) in position so that it cannot rotate on its axis (ie. torsion). Prophylactic means that
you have it done as a preventative procedure, while your dog is healthy, stable, and a minimal anesthetic risk versus an
emergency surgery when your dog has bloated or in a full GDV crisis. A pexy will not prevent bloat, but it will prevent the
rotation of the stomach. The increased time that you have to treat a dog with bloat versus a dog with torsion may mean the
difference between life and death for your dog.

There are many different gastropexy techniques; I will discuss the most common 5: Belt loop, circumcostal, incisional, ventral,
and tube gastrotomy. With any of the techniques, it is recommended to rest your dog for 3 weeks post surgery to allow the
adhesions to form. It is the adhesions (or scar tissue) that contribute the strength to the pexy. Sutures that are placed at the time
of surgery will eventually break down and will not help to prevent the stomach from rotating. This is why it is important to have
a pexy as opposed to just a tack.
 

Type of Gastropexy	Pros	Cons
Belt Loop	Fast, simple, strong Decreased risk of stomach leakage Stomach fixed to Right abdominal wall	Requires more skill than incisional pexy
Circumcostal	Strong, decreased risk of stomach leakage Stomach fixed to Right abdominal wall	Risk of pneumothorax, risk of rib fracture. Requires more time to do, more difficult
Incisional	Fast, simple Stomach fixed to Right abdominal wall Decreased risk of stomach leakage	More variation in healing and resultant strength Relies on only a few sutures in place until adhesion forms
Ventral	Fast, Decreased risk of stomach leakage	Adhesions may impair future surgery if ever needed Difficult due to depth of the BH abdomen
Tube gastrotomy	Strong adhesions Allows for release of built up gas/fluid post GDV	Stomach has to be opened to insert tube risk of leakage Special post-op management, not as strong as other techniques, premature failure of tube, peritonitis, possible persistent fistula

References:Ventral Gastropexy:JAVMA Nov 1993
(the following are all from Slatter, Textbook of Small Animal Surgery, Vol. 1 2nd Ed.)
Belt Loop Gastropexy p. 587-588, Circumcostal Gastropexy: p. 586-587
Incisional Gastropexy: p. 588-590, Tube Gastropexy: p. 586