Gastric Dilatation-Volvulus (GDV) Surgery

GDV surgery is not elective — it is the only treatment for a stomach that has twisted. Every element of the procedure is necessary:

• Stomach decompression — releasing the trapped gas immediately reduces pressure on the diaphragm (which makes breathing difficult) and the major abdominal veins
• Stomach de-rotation — returning the stomach to its normal position restores blood flow and prevents further ischemic (oxygen-deprivation) damage
• Assessment of tissue viability — sections of stomach wall or spleen that have lost blood supply and become necrotic (dead) must be removed; leaving necrotic tissue would be fatal
• Gastropexy — the stomach is permanently tacked to the abdominal wall to prevent re-rotation, which would otherwise occur in the majority of surviving dogs

Without surgery, the mortality rate from GDV is essentially 100%. With timely surgery, survival rates are significantly higher — but the window narrows with each passing hour as shock deepens and more tissue dies.

GDV surgery begins the moment the patient is stable enough for general anesthesia — stabilization and surgery happen in parallel, not sequentially:

• IV catheters are placed immediately and aggressive IV fluid resuscitation begins to treat shock while pre-op prep proceeds
• The stomach is decompressed before surgery by passing a tube through the mouth or via a large needle through the abdominal wall — this alone provides critical relief
• Under general anesthesia, a long midline abdominal incision provides wide access to the displaced stomach and spleen
• The stomach is manually de-rotated back into its normal position and inspected — the entire circumference of the stomach and spleen is evaluated for areas of non-viable (black or gray) tissue
• The spleen is removed if it has been compromised by vascular twisting (concurrent splenectomy is common in GDV surgery)
• Any non-viable segments of the stomach wall are resected; this is called partial gastrectomy
• A right-side incisional gastropexy is performed — the stomach is sutured to the right body wall with a strong, permanent attachment that prevents re-volvulus
• The abdomen is lavaged (rinsed) and closed

Total surgery time is typically 1.5 to 3 hours depending on how much tissue is involved.

GDV is a true emergency — preparation happens in minutes, not hours. On arrival:

• IV access is established and fluid resuscitation is started immediately to address shock
• Blood pressure, ECG, and oxygen levels are monitored from the moment of admission
• Bloodwork is drawn to assess organ function, clotting, and electrolyte levels — results guide anesthesia and post-op management
• Abdominal X-rays confirm the diagnosis and show the characteristic "double-bubble" or compartmentalization of the rotated stomach
• Cardiac arrhythmias, particularly ventricular premature contractions (VPCs), are common in GDV and may be treated before or after surgery

Owners should know: authorization for surgery is obtained as quickly as possible because delay costs tissue and lives. The team communicates with you throughout but cannot pause to wait — speed is part of the treatment.

GDV recovery is intensive because the body has been through shock, anesthesia, and major surgery all at once:

• ICU monitoring (1–3 days): continuous ECG for arrhythmias, blood pressure monitoring, IV fluids, pain control, anti-nausea medications, and serial bloodwork to catch electrolyte imbalances or signs of continued tissue breakdown
• Feeding protocol: small amounts of water are offered first, followed by small, bland, soft meals once vomiting is controlled — the stomach needs to recover its motility gradually
• Days 5–14 at home: strict rest, leash walks only, small frequent meals of easily digestible food, oral pain medications and stomach-protecting drugs
• Week 2 recheck: incision inspection, bloodwork, and assessment of appetite and energy
• Weeks 3–6: gradual return to normal diet and activity

If a gastropexy was performed (and it always should be at the time of GDV surgery), the risk of the stomach re-twisting is essentially eliminated. The dog that had GDV can return to a full, active life.

GDV surgery carries genuine risk, and owners deserve an honest picture:

• Overall survival with surgery is significantly better than without, but cases with extensive gastric necrosis, uncontrolled arrhythmias, or severe shock at presentation carry higher mortality
• Cardiac arrhythmias are the most common post-operative complication and are monitored closely for 24–72 hours — most resolve with time or short-term medication
• Reperfusion injury occurs when blood returns to ischemic tissue after de-rotation, releasing inflammatory compounds — IV antioxidant support and monitoring address this
• Peritonitis risk exists if stomach or intestinal contents leaked before or during surgery — abdominal lavage and antibiotics address this
• Dogs that had portions of the stomach removed (partial gastrectomy) may need dietary modification long-term

For owners of at-risk breeds who survived GDV, the best next step is a frank conversation about prophylactic gastropexy for any other at-risk dogs in the household — it prevents the condition from ever occurring.