The operator visualizes the relation of the stomach to the anterior abdominal wall and then with Allis' forceps outlines a rectangular flap, the base of which is placed near the greater curvature to ensure an adequate blood supply (Figure 7). Because the flap, when cut, contracts, it is made somewhat larger than would appear to be necessary to avoid subsequent interference with its blood supply when the flap is approximated about the catheter. The gastric wall is divided between the Allis clamps near the lesser curvature, and a rectangular flap is developed by extending the incision on either side toward the Allis clamps on the greater curvature. To prevent soiling from the gastric contents and to control bleeding, long, straight enterostomy clamps may be applied to the stomach both above and below the operative site. The flap of gastric wall is pulled downward, and the catheter is placed along the inner surface of the flap (Figure 8). The mucous membrane is closed with a continuous suture or interrupted 0000 nonabsorbable sutures (Figure 9). The outer layer, which includes the serosa and submucosa, is also closed either with continuous absorbable sutures or, preferably, by a series of interrupted nonabsorbable sutures (Figure 10). When this cone-shaped entrance to the stomach has been completed about the catheter, the anterior gastric wall is attached to the peritoneum at the suture line with additional nonabsorbable 00 sutures (Figure 11). A gastric tube can be constructed with a stapling instrument.