First the surgeons separated the lower part of the duodenum from the jejunum with the GIA, sealing both ends. Then they made an anastomosis between the esophagus and the jejunum 40 cm below the ligament of Treitz. Finally they made an anastomosis between the bottom part of the duodenum and the jejunum 40 cm below the first anastomosis. The upper part of the duodenum was left closed. So the food would go directly from the esophagus to the jejunum, and join with the gastric juices from the duodenum after 40 cm. The surgeons explained it to me as they were working, but I didn’t really get it until I looked up an illustration in a book the next day (photo credit). Advanced plumbing indeed.
The surgical procedure is quite straightforward.
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