The gastrojejunal anastomosis may be made over the entire length of the gastric outlet, or the outlet may be partly closed and the stoma limited in size. The full thickness of the gastric wall, including the staples, is excised to provide a stoma three to four fingers wide (Figure 42). Any retained gastric contents are aspirated, and all bleeding points in the mucosa of the gastric wall are controlled. The serosa of the jejunum near the mesenteric border then is anchored to the posterior wall of the stomach from one curvature to the other with 000 silk (Figure 43). The jejunum should be approximated loosely so that there is some laxity between the anastomosis of the pancreas and the gastric wall in the region of the lesser curvature. An opening about two fingers wide is made in the jejunum, and the gastrojejunal mucosa is approximated with interrupted 0000 absorbable sutures (Figure 43). The gastrojejunal anastomosis is then completed with a layer of interrupted 0000 nonabsorbable sutures, with the knots buried on the inside. The second layer of the gastrojejunal anastomosis is then completed with a layer of interrupted 000 sutures from one curvature to the other (Figure 44). The opening in the mesocolon should be approximated to the jejunal wall (Figure 44) to prevent prolapse of small bowel up through this opening. The opening about the region of the ligament of Treitz should be closed with ooo silk. A gastrostomy tube and feeding jejunostomy may be indicated in the malnourished patient. Closed-suction drains are placed adjacent to the choledochojejunostomy and pancreaticojejunostomy.