To the Editor.–In the September issue of the Archives (111:955-957, 1976), Drs Chung and Den Besten reported on the use of duodenojejunostomy to accomplish a secure closure of a difficult duodenal stump. For all its advantages, this procedure is not simple and easily performed. It prolongs the operative time, requires an additional anastomosis, and increases the possibility of a marginal ulceration. Overlying suturing of an intact segment of the jejunum over the open end of the duodenal stump seems to be an easier and better approach to the problem. It may be performed in either a loop or Roux-en-Y fashion, can be accomplished quickly, and provides a safe closure of a difficult or even a perforated duodenal stump. The rationale of this procedure, introduced by Jones et al,1 is the same as that of the serosal grafting.
Serosal patch grafting has been proved valuable by both experimental and clinical