The location of the stoma is first outlined on the anterior gastric wall with Babcock's forceps. The greater omentum may be brought outside the wound so that the contour of the stomach is not distorted, and the most dependent portion of the greater curvature may be more accurately determined (Figure 2). The Babcock forceps are left in place as the greater omentum is reflected upward over the stomach and the inferior aspect of the mesocolon is visualized (Figure 3). The transverse colon is held firmly by an assistant as the surgeon invaginates the Babcock forceps on the anterior gastric wall. This produces a bulge in the mesentery of the colon at the point through which the stomach is to be drawn (Figure 3). The mesocolon is carefully incised to the left of the middle colic vessels and near the ligament of Treitz, great care being taken to avoid any of the large vessels in the arcade. Four to six guide sutures (sutures a, b, c, d, e, and f) are placed in the margins of the incised mesocolon to be utilized after the anastomosis to the stomach at the proper level. The presenting posterior wall of the stomach is grasped with a Babcock forceps adjacent to the lesser and greater curvatures, and opposite the points of counter pressure from the similarly placed forceps on the anterior gastric wall (Figure 4). A portion of the gastric wall is pulled through the opening. In many instances, the inflammatory reaction associated with the duodenal ulcer may anchor the posterior surface of the antrum to the capsule of the pancreas. Sharp and blunt dissection may be required to mobilize the stomach in order to ensure placement of the stoma sufficiently near the pylorus. Some surgeons prefer to anchor the mesocolon to the stomach at this time. The forceps on the greater curvature is swung toward the operator on the patient's right side, while the forceps on the lesser curvature is rotated to a position opposite the first assistant.