Approximately three full-thickness sutures (Figure 3, X, Y, and Z) are required to satisfactorily approximate the tissues in readiness for the stapler as the Babcock forceps are removed. The laxity of the tissues may determine the amount of gastric and duodenal wall that extends beyond the linear stapler (TLH 90) stapling instrument, and excess tissue is subsequently removed with the scalpel. The combined thickness of the duodenal and gastric walls determines the height of the staple to be used. The taller 5.5-mm staple is most commonly needed. Additional interrupted sutures are taken if there is residual bleeding from the line of staples.