Gastroduodenostomy is a surgical procedure which changes the route food passes out of the stomach, so that it bypasses the usual exit value, the pylorus.
Gastroduodenostomy is the treatment of choice when there is a severe reduction of the width of the pylorus (the exit to the stomach) such that food is unable to pass along and enter the intestine. Think of a block U-bend under the sink, and when you re-plumb the piping to bypass the U-bend, the drain can empty out.
This procedure is uncommon, and whilst not unduly technically demanding, a vet in first opinion practice may suggest referral to a specialist surgeon with more experience performing the procedure.
Imaging such as contrast radiographic studies or endoscopy is used to determine the need for a gastroduodenostomy.
The dog is prepared for surgery with pain relief and intravenous fluids. A full general anesthetic is required, and the dog's belly is clipped and scrubbed ready for aseptic surgery.
The surgeon performs a laparotomy (opening into the abdomen). They locate the stomach and identify the area of the pylorus. This is then isolated from the rest of the abdomen so that any accidental spillage of intestinal contents doesn't contaminate the surgical site.
The pylorus is removed and a stomach sewn up. A new 'hole' or stoma is created in the stomach wall close to the area of the original pylorus. The duodenum (the part of the intestine food enters from the pylorus) is then sutured into that stoma to form a new exit.
The abdomen is closed and the dog woken from anesthesia. The patient is monitored to check they are able to eat and there is no sign of complications before being allowed home. Sutures are removed from the skin after 10 to 14 days.
Gastroduodenostomy is an extremely effective and simple way of bypassing a blocked pylorus. This can be life-changing in a dog's ability to eat and keep food down. When the cause is a benign tumor which is completely removed, the surgery can be curative.
Unfortunately, some more aggressive stomach cancers may have already spread and so the improvement is only temporary and the dog will eventually succumb to the cancer.
When all goes well the dog's digestive tract is fully healed after two weeks. They should take life easy for another two weeks to allow full healing of the belly wall.
Once discharged, the dog has a post operative check two to three days later. The owner should be vigilant for vomiting or dullness in the dog and notify the vet if this happens.
Complications include leakage from the anastomosis site (the suture line) in the stomach or wound breakdown. This can lead to spillage of gut contents into the abdomen and the development of peritonitis. This is life-threatening and needs repeat surgery in order to rectify the problem.
The cost of surgery is in addition to that of initial investigation, including sedation ($75 upwards) and endoscopy ($200 to $300 upwards). A general anesthetic is in the region of $90 minimum (per half hour) with larger dogs incurring additional charges. Laparotomy is time-consuming and this is reflected in fees of around $400 and up, with the actual surgical procedure being priced according to the time taken and likely to be $400 upwards.
Gastroduodenostomy is a procedure that has benefits and risks at the extreme end of the scale. A successful surgery is life-enhancing and is curative for certain conditions, however, complications such as operation site breakdown are life-threatening. The latter incurs repeat surgery and extensive nursing if the dog is to stand a chance of recovery.
In addition, handling the delicate tissue around the pylorus can induce complications such as pancreatitis or bile duct obstruction, which are problems in their own right.
The surgeon may consider other, slightly more conservative options such as pylorectomy (making a partial thickness incision to allow the pylorus to stretch more effectively). However, these avenues are not appropriate if cancer is infiltrating the area.
Sadly, many of the problems that account for the need for a gastroduodenostomy are not preventable and arise for reasons beyond our control. The exception is the feeding of hot food, which could lead to scar tissue forming in the region of the pylorus. Thus, dogs should be kept away from hot barbecues where they are liable to steal hot burgers and wolf them down with unhappy consequences.
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