Transect the antrum of the stomach with a linear cutting stapler at the third or fourth transverse vein on the lesser curvature and at the confluence of the gastroepiploic veins on the greater curvature (A-1).
Divide the omentum at the site of transection of the greater curvature transection.
Pylorus preservation may be considered in patients with small periampullary neoplasms. It should not be performed in patients with bulky neoplasms of the pancreatic head, neoplasms involving the first or second portions of the duodenum, or lesions associated with grossly positive pyloric or peripyloric lymph nodes (A-2).
Divide the gastroepiploic arcade and the duodenum at least 3 cm beyond the pylorus whenever possible. However, at the time of reconstruction, we trim another 1.0-1.5cm off of the duodenum to create the duodenojejunostomy 1.0-1.5cm from the pylorus to ensure an adequate blood supply to the duodenum.
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