■ After insertion of all backwall stitches, they are then railroaded down to the anastomosis using a wet swab on a stick. It is very important to hold the ends of all threads under firm tension to ease this maneuver (E).
■ The anterior wall of the anastomosis is closed with a continuous suture if there is a good view or with interrupted sutures when the view is less satisfactory. The anterior wall anastomosis is also begun at the far corner using an extramucosal stitch on the small-bowel side and a full thickness stitch on the esophagus wall. Before completing the front wall, the gastric tube is led down into the jejunum (F).
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