A jejunojejunal anastomosis is done at least 40 cm from the gastrojejunal anastomosis (Figure 10). A two-layer anastomosis is performed, and all openings in the mesenteries are closed to avoid any chance of herniation or obstruction about the anastomosis (Figure 11). A long Levin tube is directed through the anastomosis and may be directed around into the duodenum to ensure decompression of the duodenal stump. Some prefer to perform a temporary gastrostomy, provided the gastric pouch can be attached easily to the overlying peritoneum. The gallbladder, if present, should be compressed to confirm the patency of the ductal system following the procedure. After a thorough search for needles, instruments, and sponges, and affirming a correct count, the abdomen is closed.