An area is chosen approximately 15 cm distal to the ligament of Treitz in a position which will facilitate easy performance of the jejunojejunostomy. The mesenteric attachments are divided between clamps to mobilize the Roux limb. A GIA stapling device is utilized to divide the jejunum at this site.
The avascular area is then chosen in the left transverse mesocolon. A window is created through which the distal divided end of jejunum may be brought. It is important to avoid undue tension at the mesentery; at times, it is necessary to divide the truncal branches of the jejunal mesenteric vessels below the arcade to permit a flexible limb. The divided end of jejunum is aligned toward the head of the pancreas, and a side-to-side approach is established.
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