Modified procedure with a surgical stapler for construction of a Pavlov pouch in dogs

An aim of this study was to establish a simple method for the construction of a Pavlov pouch that is free of fistula formation between the main part of the stomach and the pouch, yet preserves maximal vagal innervation. The Pavlov pouch (vagally innervated gastric pouch) was constructed from the greater curvature of the gastric corpus at the level of the splenic hilus in four dogs. The plane between the mucosal and seromuscular layers was dissected bluntly along the medial margin of the pouch. A surgical stapler was introduced into the space between the mucosal and seromuscular layers, and the pouch was completely separated from the main part of the stomach enterically at the mucosal level but remained connected via the seromuscular layers. All dogs survived the operation and lost minimal weight; fistulas were not found between the remnant stomach and the pouch at necropsy 6 to 8 weeks later. Gastric acid secretion for 30 to 90 min after insulin-induced hypoglycemia, which increases vagal tone, was significantly increased compared to that before insulin injection, confirming preservation of vagal innervation to the pouch. Our technique to create a Pavlov pouch is superior to the methods reported previously because of its simplicity, lower prevalence of fistula formation, and reliable preservation of vagal innervation to the pouch.