STEP 5Anterior wall anastomosis

Traction on the corner sutures ensures that the corner is inverted. The corner may then be cut.

Sutures are placed from outside to in (A).

All are placed before tying (B).

The enterotomy should be shorter than the choledochotomy as the small intestine always stretches during creation of the anastomosis. This can cause a size mismatch (C).

Do not stent the anastomosis.

[Editor's variation: An even more facile method of completing this anastomosis is to place two absorbable sutures (3-0 vinyl) at the 6 o'clock position (D). The two sutures are then sewn in a running manner from 6 o'clock to 12 o'clock (E) and tied (F).]

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