The closed end of the stomach is reflected to the left, and the posterior gastric wall is grasped with a Babcock forceps 3 to 5 cm from the midportion of the staple line closing the distal stomach. A gastric purse string using a nonabsorbable suture is placed full thickness through the gastric wall about the Babcock. The central point is opened with an electrocautery puncture. The circular stapler (EEA) of the appropriate size is entered into the stomach with its detachable pointed plastic trocar exiting the back wall of the stomach through the punctate opening in the center of the purse string. The plastic trocar is removed and replaced with the metal anvil cap. The gastric wall is then securely closed with the purse string (Figure 2). The cap is screwed onto the tip of the center rod and it is inserted into the duodenum (Figure 3). The monofilament polypropylene purse string around the end of the duodenum is snugged and securely tied (Figure 4). The wing nut on the near end of the circular stapler (EEA) handle is turned until the stomach and the duodenum are firmly approximated. The safe zone indicator is checked to be certain that the thickness of the combined stomach and duodenum are within correct range of the staples. The safety is released, and the outside handles are squeezed. A double staggered, circular tow of staples is created, and an internal circular knife cuts the bowel walls within the staple lines simultaneously. The wing nut is loosened so that the anvils open, and the stapling instrument is gently removed (Figure 5). The doughnuts of tissue are carefully inspected to be certain there is no defect or discontinuity in the anastomosis. Several additional interrupted sutures may be placed to reinforce the anastomosis. The outer-wall gastrotomy opening is closed with a mucosa-to-mucosa noncutting linear stapler (TA 60) (Figure 6).