STEP 4Posterior wall anastomosis

The anastomosis is performed using interrupted 3-0 absorbable sutures with knots in the lumen for the posterior wall. It is a mistake to place too many sutures; 12 are usually sufficient and the anastomosis may be visualized as a clockface.

The first suture should be placed in the 6 o'clock position (A). Traction on this suture aids in exposure for subsequent posterior wall sutures.

A further three sutures are placed out to the 3 o'clock position and three to the 9 o'clock position. All sutures are placed before tying (B).

The silk stay-sutures are removed. The anastomotic sutures are tied and all but the corner sutures are cut (C).

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