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Figure 9-9 A useful adjunctive procedure In severe duodenal Injuries and pancreaticoduodenal Injuries is the pyloric exclusion. Through a gastrostomy in the dependent portion of the distal stomach, the pylorus is sewn closed with nonabsorbable suture material. Alternatively, a row of staples may be placed across the duodenum, distal to the pylorus. A gastrojejunostomy is then performed.

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