STEP 1Dissection of the jejunum

The ligament of Treitz is identified, and the jejunum is dissected about 40-50 cm distal to Treitz' ligament (A). For convenience, a stapler device may be used. The blind end of the distal part is closed using a running suture or single stitches. The distal loop is placed side-to-side to the posterior wall of the gastric remnant without exerting any tension on the mesentery. A retrocolic route is preferable. Before performing the anastomosis, the serosa of the jejunal loop is fixed to the serosa of the gastric remnant over a distance of 5-6cm, thus building the outer layer of the backward suture (B).

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