Nifty Trip for GDVs

From Episode 169 on the Surgery Stream. With Dr Nicole Buote.

I previously mentioned an article that discussed delayed surgery for GDV’s, where they used nasal catheters to keep the stomach deflated while the patient wait for surgery.  But I’ve since heard a lot of criticism of this paper, with the overwhelming response from both criticalists and surgeons that you should cut the GDV as soon as you can. Dr Buote confirmed this sentiment. But sometimes there are very practical reasons where surgery needs to be a bit delayed, even if it is just for a few hours. And that stomach needs to stay empty, right? That’s what’s killing your patient after all.  (“Without gastric dilatation and associated vascular compression, gastric pathological effects appear to be limited, as demonstrated in a study in which 360° gastric volvulus was experimentally induced in dogs while maintaining gastric decompression”).

Dr Nicole mentioned this paper on using a pigtail catheter to deflate the stomach, and keep it empty, as something that’s worth looking in to. So I did.  Sounds like a very elegant and low risk plan - possibly also for those cases where you can’t get a stomach tube in. Here’s the gist of it: 

• They used T-fasteners to place and secure a 5F locking  pigtail catheter into the stomach.

• The pigtail catheter has 5 drainage holes within the pigtail loop which limits the chance that the catheter will become obstructed from contact with the mucosa or intraluminal material. It also stops catheter pull-out and obviates the need for a finger-trap suture.

• In the study the catheter successfully kept the stomach empty until surgery, and caused minimal dramas to the stomach, and everything was back to normal by 7 days after the surgery. 

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