Short, lengthwise incisions in the stomach and jejunum are made by depressing the bowel and incising the scalpel several millimeters from the serosal suture and not in the middle of the presenting contents of the clamp (Figure 9). If this incision is too far from the serosal layer, too large a cuff of inverted bowel may result. In making these incisions, the operator should be careful to cut the bowel wall perpendicular to its surface, since there is always a tendency to incise the intestine obliquely, thereby leaving an irregular and unequalized mucosal layer for the next suture line (Figure 10). The larger vessels in the stomach wall are then ligated with 0000 transfixing sutures of silk. The contents of the bowel are wiped out with a small piece of gauze moistened with saline, and the mucosal incision is completed with straight scissors. The incision in the jejunum is made slightly shorter than that made in the stomach (Figure 11). With the stomach and intestine opened and cleaned, a continuous absorbable suture on straight needles is started in the midportion of the posterior mucosal layers (Figure 12). Although straight needles are shown, absorbable sutures swedged on curved needles are most commonly used. As the operator sews away from himself or herself, he or she uses a simple over-and-over suture or a lock stitch, which pulls together the mucosal layers (Figure 13). Since this suture is also used to control the blood supply, it must be kept under a tension sufficient for accurate approximation and prevention of hemorrhage, yet not completely strangulating the blood supply and hindering healing. This is a critical step. The amount of tension is adjusted by the surgeon, who should hold the suture in the left hand while he or she works with the right. The first assistant exposes the point to be sutured and pulls the needle through. Interrupted sutures are placed to secure any bleeding points that have not been controlled by the continuous suture. When the operator reaches the angle of the wound, a Connell suture, which allows inversion of the structures as they are sewn, is substituted (Figure 14). In Figure 14, for example, the needle has just entered the gastric side. It comes out on the gastric side 2 or 3 mm from its point of entrance (Figure 15). It is then crossed over, inserted through the jejunal wall from outside as in Figure 16, and comes back out through the jejunal wall before being reinserted through the gastric wall (Figure 17). After this angle has been closed, the other end, B, of the continuous suture is used to close the opposite angle in a similar fashion (Figure 18). The continuous sutures, A and B, finally meet along the anterior surface. The final bite of each suture brings it to the inner wall of the stomach and jejunum (Figure 19). The two ends are tied together with the final knot on the inside. The clamps may then be released to see whether there is any bleeding. If slight oozing persists, additional interrupted sutures may be taken to supplement the anterior mucosal layer.