STEP 2Resection

The resection margins are set at the pyloric region about 1 cm distal to the pylorus and the proximal third of the stomach (A). The duodenum is divided with the stapler device. It is recommended to make a single layer closure of the gastric incision with a running suture or single stitches. In case a stapler device is used, the serosa should be adapted with seromuscular stitches (B). The duodenal stump should be treated with special care, avoiding any tension on the suture line. For its closure, single stitches are used (C).

For the gastrojejunostomy, an omega loop, i.e., the Billroth II reconstruction (STEP 1-3), or a Roux-en-Y reconstruction (STEP 1) is used.

Billroth Omega

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