The diseased portion of bowel has been removed to the side, and a healthy segment of the proximal ileum (P) is brought down to anastomose to a healthy segment of the distal ileum (D).
The first step in this anastomosis is to place a Lembert suture of 3-0 Dexon through the mesenteric border approximately 1 cm from the edge of the mucosa. The purpose of this stitch is to take tension off the future suture line and to hold the intestine in appropriate approximation for the remainder of the anastomosis