Total gastrectomy may be necessary in some patients with primary or recurrent gastric carcinoma. In such cases, an esophagojejunostomy generally will be performed. This can be performed with a Roux-en-Y anastomosis, which can be either end to side or "J shaped"; alternatively, a jejunal loop can be brought up with an afferent and efferent limb (Figs. 3.32-3.34).
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