VETER NER CERRAH DERG S 61
Gastric Emptying of
Nondigestible
Radiopaque Markers
After Modified
Circumcostal
Gastropexy in the Dog
(Modifiye Sirkumkostal Gastropexy Yöntemi
Uygulanan Köpeklerde Gastrik Bo almanın
Sindirilemeyen Radyopak Maddelerle
Gösterilmesi)
ARICAN, M.1, EROL, M.1, UYARO LU, A.1,
KÖYLÜ, Ö.2, TURGUT, K.3
1
Department of Surgery, Faculty of Veterinary Science,
2
University of Selçuk, Konya
Department of Biochemistry Faculty of Internal
Medicine University of Selçuk, Konya
3
Department of Internal Medicine Faculty of Veterinary
Science, University of Selçuk, Konya
Veteriner Cerrahi Dergisi (2004), 10 (1-2), 61-65
ÖZET
Gastrik dilatasyon-volvulus (GDV); acil medikal ve
cerrahi müdahaleye ihtiyaç duyan, etiyolojisi tam olarak
bilinmeyen, hayati öneme sahip, öldürücü, akut bir send-
romdur. Bazı hekimler tarafından, sirkumkostal gastro-
peksi tekni i, gerginli i koruması açısından gastrik
dilatasyon-volvulus’un cerrahi yönden sa latımı için en
iyi teknik olarak bildirilmi tir.
Gastrik bo alma zamanlarının belirlenmesi için radyopak
materyallerin katı gıdalarla alınmasını takiben, mideyi
terk etme zamanları gösterecektir. Bu çalı mada, modi-
fiye edilerek hazırlanan radyopak maddelerin kullanıl-
ması köpeklerdeki sirkumkostal gastropeksi sonundaki
gastrik bo alma zamanlarını belirledi.
Bu çalı manın amacı sirkumkostal gastropeksi operas-
yonu sonucu sindirilemeyen modifiye radyopak mater-
yallerin kullanılarak gastrik bo alma zamanlarını belirle-
mektir.
Sonuç olarak, Modifiye sirkumkostal gastropeksi operas-
yonu, teknik açıdan kolay ve çabuk uygulanabilir. Ope-
rasyonu takiben 3.günde gastrik bo almayı engellemedi i
gösterilmi tir. Modifiye sirkumkostal tekni in cerrahi ve
profilaktik amaçlar için kullanabilece i önerilmi tir.
Anahtar Kelimeler: Köpek, gastrik dilatasyon, sirkum-
kostal gastropeksi, gastrik bo alma.
SUMMARY
Gastric dilatation and volvulus are acute and often fatal
disease syndrome of uncertain aetiology that requires
rapid medical and surgical intervention. Circumcostal
gastropexy has remained the favored technique by some
surgeons because of its superior strenght.
Early investigations noted that the movement of
radiopaque particles from the stomach correlated with
gastric emptying of solid food particles. In this article,
using of modified nondigestible radiopaque markers to
document gastric emptying in dogs after modified
circumcostal gastropexy operations.
The aim of the study, to document gastric emptying,
some blood count and serum chemistry in dogs after
modified circumcostal gastropexy of using modified
nondigestible radiopaque markers.
As a conclusion, modified circumcostal gastropexy is
technically simple and quick. Thus, It does not delate any
gastric emptying 3 days after operation procedure.
Modified circumcostal gastropexy could be suggested for
approaching of both surgical and prophylactic purposes.
Key Words: Dogs, gastric dilatation, circumcostal
gastropexy, gastric emptying.
INTRODUCTION
Gastric dilatation and volvulus (GDV) are acute and
often fatal disease syndrome of uncertain aetiology that
requires rapid medical and surgical intervention [10, 11,
13, 23, 25, 26]. Many fixation techniques of the stomach
to nearby structures have been described. These are
included, gastropexy, tube gastrostomy, fundic gastro-
pexy, gastrocolopexy, circumcostal gastropexy, belt loop
gastropexy and many more [3, 4, 9]. All of these methods
advantages and disadvantages have been documented.
However, it is imperative that the operative time is
minimised in order to limit surgical and anaesthetic stress
to the patient.
Numerous surgical techniques have been developed to
reduce the rate of GDV recurrence, which is estimated to
be as high as 80 % in cases in which a gastropexy
technique has not been performed [2, 5, 27]. In the 1970s
a tube gastropexy technique was commonly used [5]. In
the 1980s, the incisional gastropexy and circumcostal
gastropexy techniques gained popularity [18]. More
recently other muscle flap techniques, such as belt-loop
gastropexy and ventral line gastropexy have been come
popular [19, 20, 28].
Circumcostal gastropexy is widely accepted and
preferential technique by some surgeons because of its
superior strenght, but the procedure is time consuming
and can result in serious complications such as
perforation of the stomach and diaphragm [6, 18, 22, 29].
Indigestible solid particles have been used as a measure
of gastric emptying for decades in people suspected to
have motility defects [8]. Early investigations noted that
the movement of radiopaque particles from the stomach
correlated with gastric emptying of solid food particles
62 VETER NER CERRAH DERG S
[24]. Recently, reserachers have used barium-
impregnated polyethylene spheres (BIPS) to measure
gastric emptying of solids in dogs [12, 21]. The BIPS are
mixed with a meal and gastric emptying time is
calculated from serial radiographic examinations [21].
The aim of the study, to document gastric emptying,
some blood count and serum chemistry in dogs after
modified circumcostal gastropexy of using modified
nondigestible radiopaque markers.
MATERIALS and METHODS
Skeletally mature 6 dogs used were of unselected breed,
ages, both sexes and weighed between 15 + 5 kg. The
absence of gastrointestinal diseases was confirmed by
clinical examination. The operation procedures were
carried out by quarantine and conventional health
measures. The animals were anesthesized with
intramusculer Xylazine hydrochlorid (Rompun, Bayer
23.32 mg/ml). And initially, it was entubated for 4%
halotone and carried out 1.5-2 % halotone during the
operation. After experiments, all animals were healty and
returned back to the animals research facilities.
Heparinised venous blood samples were obtained from
each dogs under sterile conditions for times before and 3
days, 10 days and 21says after operation. Some blood
count (Hct, Hb), blood gas analyses and serum chemistry
(Na+, K+, Ca++, Cl-) were measured with ABL 555 Blood
Gas System (Radiometer,Copenhagen).
Circumcostal gastropexy
Once prepared for aseptic surgery, they were positioned
in dorsal recumbency for laparotomy. A skin incision
made from the xiphoid to the prepuce in males and from
the xiphoid to midway between the umbilicus and the
pubis in females. The subcutaneus tissue and fascia were
incised, and the peritoneal cavity was entered through an
incision in the linea alba. The falciform ligament was
incised and retracted to the right to provide wide
visualization and good access to the last palpable rib on
the right and to allow adequate visibility of the
diaphragmatic insertion. The last palpable right rib,
usually the 11th or 12th, was visualized by reflecting the
most cranial part of the linea alba and attached falciform
ligament with the left hand and pulling it laterally and
dorsally. This maneuver created a 4 to 6 cm distance
between the linea alba and gastropexy site. A 3-cm long
incision was made with scalpel over the rib through the
transversus abdominis muscle. Care was taken to identify
and avoid the diaphragmatic insertion. A 3-cm wide
tunnel was then created by sharp dissection around the
lateral aspect of the rib. Allis tissue forceps were passed
through the tunnel in a lateromedial directionend the
seromusculer layer of the stomach in the pyloric antrum
region was grasped. The forceps were then pulled back
through the tunnel in a mediolateral direction and a 3-cm
width of stomach wall was wrapped around the rib. At
this point, a surgical assistant held the allis forceps with
left hand and the linea alba with the right hand. Then the
surgeon held the allis forceps without incisions serosa to
serosa apposed using 0-1 absorbable monofilament
suture material (Polyglactin 910, Vicryl, Ethicon). The
suture was always passed deep enough to grasp the
submucosal layer on both sides of the wrap but did not
enter the gastric lumen. The laparotomy incision was
then closed routinely.
Postoperative considerations
After the surgical procedure, the cardiovasculer functions
as well as electrolyte and acid-base status are monitored
closely. Patients were not fed orally for 3 days; during
this time, they receive a balanced electrolyte solution
intravenously, at a rate of 90 mL/kg per day. Oral
feeding is institude after 3 days with small portions of
food offered five times daily, initially as a soup and later
as a paste.
Test Meal
A gastric emptying study was conducted once in each
dog. Food was with held from dogs for 18 hours before
each study, which was carried out in the morning. Water
was offered ad libitum. Additional for water was not
offered during the course of the radiographic study, and
sedation was not used. Preprandial radiography was
performed to confirm that the stomach was empty. Ten
small radiopaque markers were placed on a size 0.5 cm
diameter and 0.7 cm lenght gelatin capsule and were
administered during solid-food (25 g / kg Sportmix ®)
meal. Gelatin capsules were used to facilitate ingestion
and passage of the radiopaque markers into the stomach.
Subsequent radiography revealed markers in the food
within the stomach.
Radiographic methods
Ventrodorsal abdominal radiographs were taken once
two hour for during twelve hours to make dogs swallow
the ideal containing radiographic markers. First
radiograph was just taken after the dogs fed with
Sportmix®. Ventrodorsal abdominal radiographic views
were obtained in dogs when gastric emptying of markers
was considered to be totaly complete.
Statistical analysis of gastric emptying
Percent gastric emptying is calculated for each
radiograph by counting the number of gelatin capsules
remaining in the stomach and those that have passed out
of the stomach. The formula used is as follows:
Mar ke r out
x 100
Mar k er out + Mar k er in
The times at which 100 % gastric emptying of markers
was observed in dogs
Statistical Analysis
The data were analysed using the Wilcoxon-Rank test
(Minitab).
RESULTS
Clinical evaluation
Dogs were examined after surgery at least once daily and
monitored for complications at 21 days. Results of the
study indicated that the technique was feasible and easy

for approach. Median total surgery time was 30 minutes
(range 25-35 minutes); complications were not
encountered during surgery or recovery from anesthesia.
Because dogs rested quitely and did not have signs of
pain, additional analgesics were not administered after
recovery from anesthesia. All dogs appeared clinically
normal on the morning after surgery. Skin sutures were
removed 10 days after surgery.
Gastric emptying
Gastric emptying times are shown in table 1.
The times course of gastric emptying of radiopaque
particles mixed with a standardized solid meal in six
VETER NER CERRAH DERG S 63
dogs before modified circumcostal gastropexy, 100 %
gastric emptying time were recorded within 4 hours.
Gastric emptying was delayed 3 days after circumcostal
gastropexy when the animals start to fed with soup
meals.
Dogs subjected to circumcostal gastropexy surgery had
100 % gastric emptying times similar to those of control
dogs 10 days and 21 days after surgery.
Serum chemistry profile
Some blood count, blood gas analyses and serum
chemistry levels in dogs are shown in table 2.

Table 1. The 100 % gastric emptying time (hour) of radiopaque particles fed with a solid meal in dogs before and after surgery

A B C D
Number of Dogs Control dogs Three days after Ten days after Twentyone days after
Before gastropexy Circumcostal gastropexy Circumcostal gastropexy Circumcostal Gastropexy
Hour Hour Hour Hour

1 2 12* 6 4

2 4 10* 4 4

3 4 10* 6 4

4 4 8* 4 2

5 4 6* 4 4

6 4 8* 6 4
* p< 0.05
A & B * control & 3 days after circumcostal gastropexy
A&C control & 10 days after circumcostal gastropexy
A&D control & 21 days after circumcostal gastropexy

Table 2. Some blood count and serum chemistry profile in dogs with control and after circumcostal gastropexy

3.days after 10.days after 21.days after

Control
circumcostal circumcostal circumcostal
gastropexy gastropexy gastropexy
(mean+ SD) (mean+ SD) (mean+ SD)
(mean+ SD)
pH 7,36+0.27 7,37+0.06 7,34 +0.06 7,38+0,04
pCO2 mmHg 46,67+4,74 39,63+5,23 43,3+6,50 45,47+3,37
Hct % 44,33+7,28 41,17+15,12 41,17+4,36 41,17+2,79
Hb g/dL 14,42+2,34 13,33+4,80 13,47+1,52 15,45+0,78
+
Na mmol/L 153,38+3,93 162,90+7,40 146,13+1,79 * 150,40+2,12
K+ mmol/L 3,62+0,24 2,95+0,21 * 3,52+0,55 3,64+0,17 b
++
Ca mmol/L 0,93+0,15 0,56+0,09 * 0,69+0,2 0,79+0,07
Glu mg/dL 87,33+13,52 98,67+12,50 86,67+8,59 84,17+9,85
BE mmol/L 1,82+1,90 3,12+3,22 5,05+2,56 1,90+1,14
HCO-3 mmol/L 26,93+2,44 23,47+4,33 23,95+5,92 25,73+2,03
Clor mEq/L 106,00+0,63 106,67+5,24 109,00+7,85 108,17+2,71
* p<0.05
control & 3 days after circumcostal gastropexy
control & 10 days after circumcostal gastropexy
control & 21 days after circumcostal gastropexy
64 VETER NER CERRAH DERG S
Sodium levels are decreased dogs 10 days after
circumcostal gastropexy compare with control dogs
before gastropexy, 10 days and 21 days after modified
circumcostal gastropexy (p<0.05).
Potasium and calcium levels are decreased dogs 3 days
after circumcostal gastropexy
compare with control dogs (p<0.05).
Blood count (Hct,Hb) and some serum chemistry (Cl-,
glucose, acid-base status) markers were not shown any
significant differences compare with before and after
gastropexy operations.
DISCUSSION
The goal of any gastropexy is to permanently fix the
stomach to the abdominal wall in an anatomic position
that prevents stomach rotation. Obviously the best
technique is quick and safe and provides an adequate
permanent adhesions.
The advantages of the classic circumcostal gastropexy
are that it is stronger than the tube and incisional
gastropexy does not require prolonged hospitalization,
and eliminates the risk of the removing a gastrostomy
tube [9]. Also classic circumcostal gastropexy does not
impair gastric motility [4, 14, 16, 17, 22].
In this study, using of modified circumcostal technique is
less time-consuming and easier to perform than the
original technique. In the original technique it can be
difficult to create the two flaps, and the gastric lumen can
be easily perforated especially in dogs with a thin and
distended gastric wall. Degna et al., (2001) [6] mentioned
similar result of their study.
Clinical evaluation of dogs show that they were
examined after surgery at least once daily and monitored
for complications during the study. Complications were
not encountered during surgery or recovery from
anesthesia. Modified circumcostal techniques are safe to
use for dogs with GDV problems. On the other hand,
another study suggested that the circumcostal gastropexy
procedure also does not cause major alterations in gastric
electrical and contractile activities [1, 7, 15].
The noninvasive radiographic technique used to assess
gastric emptying in our study was easily performed,
economical and acceptable to the dogs. Hall et al., (1992)
[16] suggested that Radioisotopic methods are well
tolerated and if available, provide the most accurate
means of evaluating gastric emptying. In this study,
markers 0.5 cm in diameter and 0.7 cm long were used.
Therefore, we predicted that the radiopaque particles
would pass in the fed state along with the meal. On the
basis of visual inspection of radiographs most of these
markers passed with food in the fed state. However,
some of the particles remained in the stomach after food
had passed. Total gastric emptying time in dog, using
mini chunks meals (25 g / kg Sportmix®). A barium-
meal contrast procedure was reported to range from 5 to
10 hours in one study and 7- 15 hours in another study.
Because the rate of gastric emptying of a meal can be
predicted on the basis of energy density and initial meal
volume. In this study, dogs subjected to modified
circumcostal gastropexy surgery had 100 % gastric
emptying times similar to those of control dogs 10 days
and 21 days after surgery. The other important finding in
the study was that circumcostal gastropexy does not
appear to alter gastric emptying in experimental dogs.
Eventhough, thus, circumcostal gastropexy could be
recomended as prophylactic surgery in healty dogs of
breeds prone to develop GDV, because abnormalities of
gastric emptying are unlikely as a result of the surgery.
In the study, hypokalemia and hypocalcaemia have been
seen 3 days after circumcostal operation. Hypokalemia is
the most common electrolyte abnormality, resulting from
excessive loss of potasium because of anorexia.
Hypocalcemie could be result of delayed of gastric
emptying of 3 days after circumcostal gastropexy. So,
decrease level of calcium and potassium concentrations
were became normal levels when the dogs fed orally with
small portions of food. During the study, we have not
seen any cardiac arrhythmias, this could be indicate that
modified circumcostal gastropexy was not effect in
electrolyte concentration imbalances and acid-base
abnormalities.
As a conclusion, modified circumcostal gastropexy is
technically simple and easily learned. The method is
rapid, does not prolong the surgical time, and keeps
duration of anesthesia as short as possible. The integrity
of the gastropexy site easily can be assessed
radiographically. Any complication has not been seen
after operations. Thus, it does not delate any gastric
emptying 3 days after operation procedure. Therefore,
modified circumcostal gastropexy could be suggested for
approaching of both surgical and prophylactic purposes.
REFERENCES
1. Bebchuk, T.N., Hauptman, J.G., Braselton, W.E.,
Walshaw, R.: Intracellular magnesium concentrations in
dogs with gastric dilatation-volvulus. American Journal
of Veterinary Research 2000, 61, 1415-1417.
2. Betts, C.W., Wingfield, W.E., Greene, R.W.: A
retrospective study of gastric dilatation-torsion in the
dog. Journal of Small Animal Practice 1974, 15, 727-
734.
3. Clark, G.N., Spodnick, G.J., Rush, J.E., Keyes,
M.L.: Belt loop gastropexy in the management of
gastroesophageal intussusception in a pup. Journal of the
American Veterinary Medical Association 1992, 201,
739-742.
4. Collins, F.: Circumcostal gastropexy. Journal of the
American Veterinary Medical Association 1994, 205,
536.
5. De Hoff, W.D., Green, R.W.: Gastric dilatation and
gastric torsion complex. Veterinary Clinics North
America 1972, 2, 141-153.
6. Degna, M.T., Formaggini, L., Fondati, A. and
Assin, R.: Using a modified gastropexy technique to
prevent recurrence of gastric dilatation-volvulus in dogs.
Veterinary Medicine. 2001, 39-50.

7. Eggertsdottir, A.V., Stigen, Y.O., Lonaas, L.,
Langeland, M., Devor, M., Vibe-Petersen, G. and
Eriksen, T.: Comparison of the recurrence rate of gastric
dilatation with or without volvulus in dogs after
circumcostal gastropexy versus gastrocolopexy.
Veterinary Surgery 2001, 30, 546-51.
8. Feldman, M., Smith, H.J. and Simon, T.R.:
Gastric emptying of solid radiopaque markers: Studies
healty subjects and diabetic patients. Gastroenterelogy.
1984, 87, 895-902.
9. Flanders, J.A. and Harvey, H.J.: Results of tube
gastrostomy as treatment of gastric volvulus in the dog.
Journal of the American Veterinary Medical Association
1984, 185, 74-77.
10. Glickman, L.T., Glickman, N.W., Schellenberg,
DB., Raghavan, M. and Lee, T.: Non-dietary risk
factors for gastric dilatation-volvulus in large and giant
breed dogs. Journal of the American Veterinary Medical
Association 2002, 15, 1492-1499.
11. Glickman, L.T., Glickman, N.W., Schellenberg,
DB., Raghavan, M. and Lee, T.: Incidence of and
breed-related risk factors for gastric dilatation-volvulus
in dogs. Journal of the American Veterinary Medical
Association 2000, 1, 40-45.
12. Guilford, W.G., Lawoko, C.R. and Allan, F.J.:
Accuracy of localizing radiopaque markers by abdominal
radiography and correlation between their gastric
emptying rate and that of a canned food in dogs.
American Journal of Veterinary Research 1997, 58,
1359-1363.
13. Hall, J. A.: Clinically evaluating gastric diseases in
dogs and cats. Veterinary Medicine. 2000, 450- 465.
14. Hall, J. A., Willer, R.L., Seim, H. B. and Powers,
B.E.: Gross and histologic evaluation of hepatogastric
ligaments in clinically normal dogs and dogs with gastric
dilatation-volvulus. American Journal of Veterinary
Research 1995, 52, 1611-1614.
15. Hall, J. A., Willer, R.L., Solie, T.N. and Twedt,
D.C.: Effect of circumcostal gastropexy on gastric
myoelectric and motor activity in dogs. Journal of Small
Animal Practice. 1997, 38, 200-207.
16. Hall, J.A., Willer, R.L., Seim, H.B. and Lebel,
J.L.: Gastric emptying of nondigestible radiopaque
markers after circumcostal gastropexy in clinically
normal dogs and dogs with gastric dilatation-volvulus.
American Journal of Veterinary Research 1992, 53,
1961-1965.
17. Konde, L.J., Wingfield, W.E. and Twedt, D.C.:
Circumcostal gastropexy for preventing recurrence of
gastric dilatation-volvulus in the dog: An evaluation of
30 cases. Journal of the American Veterinary Medical
Association 1985, 187, 245-248.
18. Leib, M.S. and Blass, C.E.: Gastric dilatation
volvulus in dogs: An update. Compendium Cont.
Education 1984, 6, 961-969.
19. Meyer-Lindenberg, A.: The ventral midline gastro-
pexy. In; Current techniques in small animal surgery.
VETER NER CERRAH DERG S 65
Edt, Bojrab, M.J. Williams and Wilkins, Philadelp-
hia.1990, 241-243.
20. Meyer-Lindenberg, A., Harder, A., Fehr, M.,
Luerssen, D. and Brunnberg, L.: Treatment of gastric
dilatation-volvulus and a rapid method for prevention of
relapse in dogs: 134 cases (1988-1991). Journal of the
American Veterinary Medical Association 1993, 203,
1303-1307.
21. Nelson, O.L., Jergens, A.E. and Miles, K.G.:
Using barium-impregnated polyethylene spheres to
document delayed gastric emptying. Veterinary
Medicine, 1996, 984-998.
22. Pope, E.R. and Jones, B.D.: Clinical evaluation of a
modified circumcostal gastropexy in dogs. Journal of the
American Veterinary Medical Association 1999, 215,
952-955.
23. Rawlings, C.A., Mahaffey, M.B., Bement, S. and
Canalis, C.: Prospective evaluation of laparoscopic-
assisted gastropexy in dogs susceptible to gastric
dilatation. Journal of the American Veterinary Medical
Association 2002, 1, 1576-1581.
24. Smith, H.J. and Feldman, M.: Influence of food
and marker length on gastric emptying of indigestible
radiopaque markers in healthy humans.Gastroenterology.
1986, 91, 1452-1455.
25. Tanno, F., Weber, U., Wacker, C.H., Gaschen, L.,
Schmid, V. and Lang, J.: Ultrasonograhic comparisonof
adhesions induced by two different methods of
gastropexy in the dog. Journal of Small Animal Practice.
1998, 39, 432-436.
26. Turgut, K. and Ok, M.: Kedi ve köpek
gastroenterolojisi. 2001 Konya.
27. Wagner, A.E., Dunlop, C.I. and Chapman, P.L.:
Cardiopulmonary measurements in dogs undergoing
gastropexy without gastrectomy for correction of gastric
dilatation-volvulus. Journal of the American Veterinary
Medical Association 1999, 215, 484-488.
28. Whitney, W., Scavelli, T., Matthisen, D. and
Burk, R.: Belt-loop gastropexy: Technique and surgical
results in 20 dogs. Journal of The American Animal
Hospital Association 1989, 25, 75-83.
29. Wolfson, J. and Kostolich, M.: Circumcostal
gastropexy: clinical use of the technique in 34 dogs with
gastric dilatation-volvulus. Journal of The American
Animal Hospital Association 1986, 22, 825-830.