Preparation of Stomach Pouch Without Interruption of Vagal Supply. ∗

As demonstrated previously, 1 the ventral and dorsal gastric vagus trunks in the dog run symmetrically with each other along the lesser curvature of the stomach. Their secondary branches pass across the stomach, transversely to its long axis (Fig. 1). The Pavlov pouch technic was based upon the erroneous anatomical concept that only the ventral trunk runs along the lesser curvature, whereas the dorsal trunk courses along the greater curvature. In consequence, the bulk of the vagal supply to the pouch was unwittingly sacrificed by the operative procedure. To determine whether there exists a physiological counterpart to this anatomical deficiency, it is necessary to compare the Pavlov type of pouch with one in which the vagi are anatomically undisturbed. Such a pouch has been successfully made in 6 animals by the following technic:

An upper abdominal incision is made slightly to the left of the midline, to avoid the falciform ligament. The stomach is delivered through the wound, milked out, and a single gastric clamp is applied parallel to its long axis and across both fundus and pylorus, as high up as the exposure will permit (Fig. 1). The abdomen is then packed off in the usual manner. The anterior vagal trunk may be seen accompanying the right and left gastric arteries along the lesser curvature of the stomach; its secondary branches accompany the secondary vascular branches (not shown) as they run transversely to the long axis of the stomach. The initial incision in the stomach starts at A on the greater curvature, abut 1 inch proximal to the junction of the pyloric antrum with the body of the stomach. From this point it runs about half way across both the anterior and posterior stomach walls in a direction parallel to the secondary vagal branches.