Handsewn single-layer anastomosis

To perform a handsewn end-to-end anastomosis, the staple lines sealing the ends of the bowel to be anastomosed are first completely excised. A stay suture is placed through the antimesenteric border of both ends of the bowel (A). This helps align the ends and allows the surgeon to keep track of appropriate suture travel. Two absorbable sutures are placed next to each other through the mesenteric border of both ends of the bowel (A). The ends of the two sutures are then tied together. Each suture is then run toward the antimesenteric border of the bowel, with one suture anastomosing the back wall of the bowel (B) while the other one anastomoses the front wall of the bowel (C). Care must be taken to take full-thickness bites ensuring mucosal inversion along the mesentery as this area is more difficult to visualize than the remaining bowel wall. Inserting the needle on the serosa deeper than the mucosal exit site helps invert the mucosa. Once the two sutures meet on the antimesenteric border of the bowel and are tied (D), the stay suture is removed.