The Roux-en-Y principle is used to create a 16-18 cm long jejunal pouch, some 42 cm distal to the esophagojejunostomy. This anastomosis can be accomplished manually or mechanically. The basic method of pouch construction with the GIA instrument shown here in the video can also be used in the creation of a Hunt-Lawrence jejunal pouch or a J-shaped ileal pouch for replacement of the colon.