A French research group from the large emergency hospital CHV des Cordeliers recently published an interesting study in Veterinary Surgery. They examined the difference between two groups that were operated on for gastric dilatation-volvulus directly after a standardized stabilization protocol lasting 90 minutes, versus a group that was operated on the morning after presentation, still with the same stabilization protocol. As we all know, gastric dilatation-volvulus patients tend to present in the evening and at night. The rationale behind the research group’s desire to examine this is that several studies published in recent years, particularly in human medicine, show worse prognosis for patients operated on during emergency shifts, while it has also been shown that patients (including dogs) operated on by a surgical specialist have better prognosis than those operated on by a non-specialist. Since specialists often work during daytime hours and not emergency shifts, the group believed it could be advantageous for patients to wait until the specialist was available during daytime.
The results were highly surprising for those of us who have believed that gastric dilatation-volvulus is a peracute event where surgery must take place very shortly after presentation. 89 dogs were operated on immediately, while 73 were stabilized pending surgery the next morning. One group was operated on 2.1 hours (median value) after presentation, the other 9.8 hours (median value) after. One dog had to wait a full 13.7 hours, without this negatively affecting the outcome. There was no difference in survival between the two groups either at discharge or one month after the procedure. Although the degree of ventricular rotation was distributed somewhat differently between the groups, the degree of gastric wall necrosis was similar and low across both groups. High lactate values 24 hours after initiated fluid therapy were found to be a negative prognostic marker for survival, both during postoperative hospitalization and up to 1 month after the procedure.
This is a brief summary, and the image is borrowed from the article. Would you like to read more? Here is a link to the article:
https://onlinelibrary.wiley.com/doi/10.1111/vsu.13763
Does this change the way you view treatment of gastric dilatation-volvulus?
