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Before performing the anastomosis, the ends should be aligned to prevent one or both sides from twisting; release the sides while ensuring good blood supply to the anastomosis and ensuring that the anastomosis is tension-free.

Place your left hand around the anastomosis to protect it from foreign body entrapment. It is important not to be too loose, nor too tight. As too loose can prevent the two walls from fitting closely, which may result in the poor anastomosis, postoperative bleeding, and anastomotic fistula; too tight may result in extrusion injury to the gastrointestinal tract, causing postoperative scarring, resulting in narrowing of the anastomosis or difficulty in withdrawing the anastomosis, and in severe cases may result in tearing of the anastomosis.

The anastomosis should be performed quickly and accurately, in one single movement, to ensure that the surgical stapler does not swing left, right, up and down, so as not to aggravate the tissue damage around the anastomosis or increase the possibility of anastomotic fistula or stenosis.

The cause of the unsuccessful anastomosis should be identified immediately and an instrumental or manual anastomosis should be performed again.

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