The senior author (E. J. P.) in 19573 described the construction of a novel-type pouch from jejunum which functions as a true reservoir holding a full meal. This operation was first done on May 11, 1956. It has since been performed 32 times following massive and total gastrectomy with various modifications, some of which were presented in 19594 (the Table). The procedure divides itself into 3 categories—those following (1) massive gastrectomy, (2) total gastrectomy, and (3) secondary replacement after a malfunctioning, previously performed operation has been done—with 2 distinct choices of technique, depending upon whether or not the duodenum can be included in the gastroenteric continuity. The basic feature of this substitution is that it has an isoperistaltic inlet proximally and an antiperistaltic outlet distally. The isoperistaltic inlet prevents regurgitation into the esophagus. Moreno,2 in a review of gastric substitution pouches in 1956, pointed out that while