Document Type : Original Article

Authors

1 Department of Surgery and Radiology, Faculty of Veterinary medicine, University of Tehran, Tehran, Iran.

2 Institute of Biomedical Research, University of Tehran, Tehran, Iran.

3 Department of Clinical Sciences, Faculty of Veterinary Medicine, Islamic Azad University, Garmsar Branch, Garmsar, Iran.

4 Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

5 Endoscopic Surgery Training Center, Tehran University of Medical Sciences, Tehran, Iran.

6 Department of Internal medicine, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.

Abstract

Pyloric stenosis is an uncommon but important gastric outflow disease. Heineke-Mikulicz (H-M) pyloroplasty is one of the pyloroplasty techniques used for the treatment of such diseases. A laparoscopic pyloroplasty is an effective and preferred alternative technique to conventional surgeries. This study aims to compare the duration of surgery, surgical stress level measurement, and postoperative pain in laparoscopic H-M pyloroplasty in normal dogs with a conventional pyloroplasty technique. Eight intact adult mixed breed dogs (5 females and 3 males) were used in this study. Animals were randomly divided into two groups of conventional open (n = 4) and laparoscopic (n = 4) H-M pyloroplasty. Blood glucose concentration, plasma cortisol level, as well as pyloric features including a pyloric lumen, pyloric diameter, pyloric width with ultrasonography, and gastric emptying time with contrast radiography and the University of Melbourne Pain Scale (UMPS) value, were measured in both groups. The mean operation time in the laparoscopic group was longer than that of the conventional group (55.00 ± 15.00 vs. 35.00 ± 4.56 min); however, this difference was not statistically significant. Blood glucose concentration in the laparoscopic group elevated rapidly until 3 hours after the operation and then decreased in 24 hours while blood glucose concentration in the conventional group slowly increased until 24 hours. The UMPS value at 3 hours after conventional H-M pyloroplasty was higher than that of laparoscopic H-M pyloroplasty (19.25 ± 0.75 vs. 6.50 ± 0.96, p < 0.001). Gastric emptying time significantly decreased in both groups. According to the results, in addition to reducing pain and stress, laparoscopic H-M pyloroplasty decreased gastric emptying time in all patients with no morbidity and appears to be a less invasive alternative technique for the management of gastric outflow disease.

Keywords

Main Subjects

  1. Sánchez‐Margallo FM, Ezquerra‐Calvo LJ, Soria‐Gálvez F, Usón‐Gargallo J. Comparison of the effect of laparoscopic and conventional pyloric surgery on gastric emptying in dogs. Veterinary Radiology & Ultrasound, 2005; 46(1): 57-62.
  2. Colin F. Burrows: Gastric Disease, In: Thomas DA, Simpson JW, Hall EJ. Eds, Manual of Canine & Feline Gastroenterology, 1996, BSAVA, 111-113.
  3. Walter MC, Goldschmidt MH, Stone EA, Dougherty JF, Matthiesen DT. Chronic hypertrophic pyloric gastropathy as a cause of pyloric obstruction in the dog. Journal of the American Veterinary Medical Association, 1985; 186(2): 157-161.
  4. Greenfield CL, Walshaw R, Thomas MW. Significance of the Heineke‐Mikulicz pyloroplasty in the treatment of gastric dilatation‐volvulus a prospective clinical study. Veterinary Surgery, 1989; 18(1): 22-26.
  5. Toro JP, Lytle NW, Patel AD, Davis Jr SS, Christie JA, Waring JP, Sweeney JF, Lin E. Efficacy of laparoscopic pyloroplasty for the treatment of gastroparesis. Journal of the American College of Surgeons, 2014; 218(4): 652-660.
  6. Papageorges M, Breton L, Bonneau NH. Gastric drainage procedures: Effects in normal dogs II. Clinical observations and gastric emptying. Veterinary Surgery, 1987; 16(5): 332-340.
  7. Stanton ME, Bright RM, Toal R, Denovo RC, McCracken MA, McLauren JB. Effects of the Y‐U pyloroplasty on gastric emptying and duodenogastric reflux in the dog. Veterinary Surgery, 1987; 16(5): 392-397.
  8. Mancini SA, Angelo JL, Peckler Z, Philp FH, Farah KF. Pyloroplasty for refractory gastroparesis. The American Surgeon, 2015; 81(7): 738-746.
  9. Sanchez-Margallo FM, Loscertales B, Díaz-Güemes I, Uson J. Technical feasibility of laparoscopic Finney pyloroplasty examined in a canine model. Surgical Endoscopy, 2007; 21(1): 136-139.
  10. Tapia-Araya AE, Díaz-Güemes Martin-Portugués I, Fresno Bermejo L, Sánchez-Margallo FM. Laparoscopic ovariectomy in dogs: Comparison between laparoendoscopic single-site and three-portal access. Journal of Veterinary Science, 2015; 16(4): 525-530.
  11. Al Chalabi H, Larkin J, Mehigan B, McCormick P. A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. International Journal of Surgery, 2015; 20: 65-74.
  12. Bowers RF, Stockard CG. Dumping syndrome following pyloroplasty. Archives of Surgery, 1966; 92(1): 39-43.
  13. Firth AM, Haldane SL. Development of a scale to evaluate postoperative pain in dogs. Journal of the American Veterinary Medical Association, 1999; 214(5): 651-659.
  14. Wei S, Tian J, Song X, Chen Y. Extracorporeal instrument knotting technique for minimal access thoracic surgery. Journal of Thoracic Disease, 2015; 7(11): 2058.
  15. Merema DK, Schoenrock EK, Le Boedec K, McMichael MA. Effects of a transdermal lidocaine patch on indicators of postoperative pain in dogs undergoing midline ovariohysterectomy. Journal of the American Veterinary Medical Association, 2017; 250(10): 1140-1147.
  16. Marcovich R, Williams AL, Seifman BD, Wolf Jr JS. A canine model to assess the biochemical stress response to laparoscopic and open surgery. Journal of Endourology, 2001; 15(10): 1005-1008.
  17. Krog AH, Thorsby PM, Sahba M, Pettersen EM, Sandven I, Jørgensen JJ, Sundhagen JO, Kazmi SS. Perioperative humoral stress response to laparoscopic versus open aortobifemoral bypass surgery. Scandinavian Journal of Clinical and Laboratory Investigation, 2017; 77(2): 83-92.
  18. Devitt CM, Cox RE, Hailey JJ. Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs. Journal of the American Veterinary Medical Association, 2005; 227(6): 921-927.
  19. Naitoh T, Garcia-Ruiz A, Vladisavljevic A, Matsuno S, Gagner M. Gastrointestinal transit and stress response after laparoscopic vs conventional distal pancreatectomy in the canine model. Surgical Endoscopy, 2002; 16(11): 1627-1630.
  20. Dozois RR, Kelly KA, Code CF. Effect of distal antrectomy on gastric emptying of liquids and solids. Gastroenterology, 1971; 61(5): 675-681.
  21. Muller-Lissner SA, Sonnenberg AM, Schattenmann GO, Hollinger AL, Siewert JR, Blum AL. Gastric emptying and postprandial duodenogastric reflux in pylorectomized dogs. American Journal of Physiology-Gastrointestinal and Liver Physiology, 1982; 242(1): G9-14.
  22. Ludwick JR, Wiley JN, Bass P. Gastric emptying following Finney pyloroplasty and vagotomy. The American Journal of Digestive Diseases, 1970; 15(4): 347-352.
  23. Lulu DJ, Lawson LJ, Dragstedt LR. Heineke-Mikulicz and Finney: Vagotomy. Archives of Surgery, 1971; 102(5): 512-515.
  24. Peeters ME. Pyloric stenosis in the dog: Developments in its surgical treatment and retrospective study in 47 patients. Tijdschrift voor Diergeneeskunde, 1991; 116(3): 137-141.