A schematic illustration of performing a gastroduodeno-plasty to cover a large duodenal defect by the distal part of a transected stomach. First a T-tube is placed into the common bile duct to decompress the duodenum (A). To mobilize the pyloric antrum the stomach is transected at the level of the Angular incisure by using a linear stapler (B.) The lesser curvature of the stomach is completely mobilized. And the greater curvature is mobilized while preserving the right gastroepiploic vessels. Beginning from the cranial edge of the duodenal defect the front wall of the proximal duodenum is widely opened dividing the pyloric canal and antrum (C). The distal transected stomach and duodenal defect are approximated by a 180 degree rotation of the distal stomach (D). The back wall of the anastomosis is sewn by single sutures. Corner stitches are placed and the front wall is completed using interrupted sutures (E). The Stapler line of the distal transected stomach is reinforced by seroserosal oversewing . The reconstruction of the gastrointestinal tract is performed in a retrocolic fashion according to Billroth II by using the first jejunal loop so that the afferent loop remains short (F).