The ideal intestinal anastomosis is the one that does not leak, for leaks, although relatively rare, represent a dreaded and potentially deadly disaster (• Chap. 50). In addition, the anastomosis should not obstruct, allowing normal function of the gastrointestinal tract within a few days of construction. Any experienced surgeon thinks that his or her anastomotic technique, adopted from mentors and with a touch of personal virtuosity, is the “best.” Many methods are practiced: end to end, end to side, or side to side; single versus double layered, interrupted versus continuous, using absorbable versus nonabsorbable and braided versus monofilament suture materials. We even know some obsessive-compulsive surgeons (do you know any?) who carefully construct a three-layered anastomosis in an interrupted fashion. Now, add staplers to the mix. So, where do we stand; what is preferable (• Fig. 13.1)?