A nasogastric sump tube (Salem n° 18) is inserted. The patient lies supine, thighs fully abducted and slightly bent. The operation table has a 20° reversed Trendelenburg tilt. The surgeon stands between the patient's legs. The first assistant is standing on the patient's left side, the second assistant on the right side.

Dissection of the esogastric junction
The dissection of the lesser omentum starts to the left of the right gastric artery and follows this one towards the hepatic hilus, follows the left side of the liver until it reaches the right pillar of the right crus. Next dissection of the anterior leaf of the esogastric and the phrenogastric ligament is carried out. Dissection is then performed from top to bottom of the right pillar while resecting a generous chunk of the muscular fibers so as to be certain to stay away from the tumor and to open extensively the hiatus. Finally, dissection is continued downwards this pillar, until the aorta is reached.

Mobilization of the greater curvature
Section of the gastrocolic ligament and thus opening of the lesser sac is carried out just lateral to the right gastro-epiploic artery. The greater curve is completely freed from bottom to top, care being taken so as not to injure the gastro-epiploic artery. Dissection of the gastrosplenic ligament is taken as far as the phrenogastric ligament. The opening in the lesser sac is widened and the posterior aspect of the antrum is dissected up to the level of the pylorus. The mesocolon is now dissected away and the omentum is sectioned. A kocher manoeuvre is performed.

Celiac node dissection and ligation of the left gastric artery
The antrum is attracted downwards. The tail of the pancreas is clearly visualized as well as the celiac trunk and the hepatic pedicle. The peritoneal leaflet joining the tail of the pancreas is dissected with the coagulating hook. All lymphoglandular tissue from that point towards the right is sampled while preserving the pyloric artery and the hepatic pedicule, toward the liver. The portal vein and the hepatic pedicle are skeletonized . The assistant seizes the perivascular fat and attracts it upwards and to the patient's left. The common hepatic artery is skeletonized until the celiac trunk is reached. The left gastric vein is dissected and is sectioned between 2 clips. Dissection of the celiac trunk with the Ultracision towards the pillars, leads to complete mobilization of all attachments of the stomach.

Gastro Enterostomy
The circular stapler was introduced through the same opening as the anvil and advanced to the hole in the bowel loop. The shaft was advanced into the lumen over some 5 cm. The spike of the circular stapler was pushed through the bowel wall by turning the handle of the stapler and the pike was joined with the anvil’s stem and clicked together. The device was fired and the stapler pulled out. The doughnuts were verified, confirming the integrity of the anastomosis.

Entero-enterostomy
A small hole was made in both limbs 1 cm from the stitch and the linear stapler white load was introduced into the openings and fired. In case 45 mm loads were used the stapler was fired twice; one firing was judged sufficient with 60 mm loads. The enterotomy openings were closed manually with silk 2/0 or PDS 3/0 (Ethicon, Neuilly, France)