The entire omentum is usually freed from the transverse colon, including both flexures in the presence of malignancy (see Plate 27, Omentectomy). The blood vessels can be controlled by the vascular double clip and cut device (LDS) instrument, which fires two staples and divides the intervening tissue with a knife. However, it is technically easy to remove the greater omentum by the technique shown in Plate 27, Figures 1, 2, 3, 4, and 5. The superior and inferior borders of the duodenum are partially freed to permit mobilization and ligation of the duodenal opening by a non cutting linear stapler (TA 30 or 55). A Kocher clamp is applied across the pyloric end of the stomach or duodenum just beyond the point where the staple line is divided with a knife (Figure 1). The duodenum should be disturbed as little as possible when a posterior penetrating ulcer is known to be present, lest perforation into the ulcer crater occur with subsequent leakage.