RT Book, Section A1 Ellison, E. Christopher A1 Zollinger, Robert M. SR Print(0) ID 1127272063 T1 GASTRECTOMY, HOFMEISTER METHOD T2 Zollinger's Atlas of Surgical Operations, 10e YR 2016 FD 2016 PB McGraw-Hill Education PP New York, NY SN 978-0-07-179755-9 LK accesssurgery.mhmedical.com/content.aspx?aid=1127272063 RD 2024/03/28 AB The schematic drawing shows the position of the viscera after this operation is completed, along with the alternative antecolic placement of the jejunal loop. In principle, this technique consists of closing about one-half of the gastric outlet adjacent to the lesser curvature and performing a gastrojejunal anastomosis adjacent to the greater curvature, with approximation of the jejunum to the entire end of the gastric remnant (figure 1). Alternatively a Roux-en-Y reconstruction should be considered in some cases to avoid significant bile reflux that can occur with a small gastric pouch. This operation is favored when very high resections are indicated, because it provides a safer closure of the lesser curvature. It may also retard sudden overdistention of the jejunum after eating. The jejunum may be brought up either anterior to the colon or through an opening in the mesocolon to the left of the middle colic vessels (Chapter 28, figure 2).