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In this suture pattern, the needle penetrates the serosa, muscularis, and submucosa, but the everting mucosal layer is not incorporated (Figure 3.1b). On the opposite side a mirror image of the needle purchase is taken; the needle incorporates the submucosa, muscularis, and serosa only. When the suture is pulled snuggly, the mucosa is buried within the lumen. This pattern can be used as a simple interrupted pattern or in a continuous fashion. Caution should be taken when considering this pattern. The downside to this modification is that the serosa and muscularis layers may be included, but because mucosal eversion hides the incised bowel edge, either the submucosa may not be included or too small of purchase if this layer is included, rendering the suture line susceptible to premature dehiscence (Kieves et al. 2014).