Figure 3. The demolitive (upper left panel) and the reconstructive (upper right panel) phases of pancreaticoduodenectomy when a sufficiently long afferent loop is present in a previous B II partial gastrectomy. In spite the afferent loop is stapled downstream the duodenojejunal flexure (upper left panel), the length of the distal end of the afferent loop allows its utilization for the pancreatic and biliary anastomoses with an adequate distance between each of the final three anastomoses (upper right panel). This procedure has been followed in Case #2. The demolitive (lower left panel) and reconstructive (lower right panel) phases follow the above described steps also when a sufficiently long afferent loop to the jejuno-jejunal anastomosis is present in a Roux-en-Y partial gastrectomy.