For postoperative gastric patients status post total gastrectomy, how do you approach anastamotic coverage?

In the Gunderson re-op studies, local regional recurrences occurred in 38% of patients when assessed clinically, 67% when assessed by re-operation and 80-90% at autopsy. Of the local recurrences, 25% occurred at the anastomosis or duodenal stump when assessed clinically or by reoperation, and 50-60%...