773 LAPAROSCOPIC FUNDOPLICATION IN A DOG WITH GASTROESOPHAGEAL REFLUX DISEASE

Antireflux procedures in humans are well stablished. However, the veterinarian literature lack of information on antireflux procedures. To our knowledge, this is the first ever documented laparoscopic fundoplication performed on a canine. A one-year male, Belgian Malinois was presented for consultation of progressive chronic regurgitation and hypersalivation. Given the persistent clinical signs despite medical management, laparoscopic fundoplication was recommended and elected. Methods Laparoscopic fundoplication was performed. The dog was induced under general anesthesia and prepared for ventral abdominal surgery in dorsal recumbency. A direct approach to the abdominal cavity was made just cranial to the umbilicus on midline and a 5 milimiter port placed routinely with a blunt trocar. Pneumoperitoneum was set at 8 to 10 millimeters of mercury. Results The patient was hospitalized postoperatively receiving methadone, maropitant, ondansetron, erythromycin, metoclopramide, pantoprazole and intravenous crystalloid fluid therapy. A liquid/soft diet was offered from 17-hours postoperatively which the dog ate readily with a normal appetite. No vomiting nor regurgitation was noted during the dog’s hospitalization. Patient was discharged 47 hours after surgery. Activity restriction was recommended for 14 days. The owner was recommended to adhere strictly to a diet comprised of a liquid consistency for the first seven days fed over three-to-four meals, followed by a slow gradual increase in consistency to canned soft food by three weeks. Conclusion Reflux is probably more prevalent in canines than previously thought and possible implementation of antireflux testing and procedures may need to be considered in this population. Video https://drive.google.com/file/d/1-H0rrRhsIXXSVaHM_iU1QVvr_BqPqIg2/view?usp=sharing.

Comparison of diagnostic yield and complications of bronchoscopy, closed pleural biopsy and medical thoracoscopic pleural biopsies in undiagnosed pleural effusions

Background: Undiagnosed exudative pleural effusion is a commonly encountered clinical scenario, which requires further evaluation. This study was aimed to analyze the diagnostic yield and complications of three procedures- Bronchoscopy, closed (Abram’s) pleural biopsy and medical thoracoscopy. Further, this study assessed whether combining closed pleural biopsy with bronchoscopy can be a substitute for medical thoracoscopy.Methods: An observational study was conducted among people with undiagnosed exudative pleural effusion. Initially, closed pleural biopsies were performed with Abrams needle and multiple tissue fragments were taken through the incision and the samples were sent in formalin to the laboratory for histopathology examination. For thoracoscopy, a cannula of 10 mm diameter with blunt trocar was inserted into the pleural cavity and semi rigid thoracoscope was introduced through the trocar. Bronchoscopy was performed 48 hours after thoracoscopy. Sensitivity, specificity and positive and negative predictive values were calculated and compared.Results: Out of 25 people, 14 were diagnosed to have malignancy and 7 were diagnosed tuberculosis. The overall sensitivity of the three procedures were 28.5% for closed pleural biopsy, 14.2% for bronchoscopy, 95.2% for medical thoracoscopy, 42.8% for the combined pleural biopsy and bronchoscopy. The complication rate was lowest for bronchoscopy (4%), followed by medical thoracoscopy (8%) and closed pleural biopsy (16%).Conclusions: Medical thoracoscopy is a comparatively safe procedure which has got the highest sensitivity for the diagnosis of undiagnosed exudative pleural effusions. Bronchoscopy combined with closed pleural biopsy, the diagnostic yield was increased (than that of individual yield), but cannot be a substitute for medical thoracoscopy.