Still today the digestive anastomoses are a subject very discuss and controversial in relation to the better technique. In fact the introduction of mechanical suture has placed the problem between this instrumentation and the classic technique. The Authors, comparing these two techniques, observe the peculiar aspects of each one and relate on the progresses, in last years, whether of the mechanical suture, with the improvement of the handy and the resistance of the anastomosis, or the threads of suture, ever more inert and resistant. Subsequently, the Authors relate your experience showing the form of realization of the anastomoses in the esophagogastric surgery, small intestine, colon-rectum, hepato-biliary and pancreatic surgery. In particularly, about the hand-sewn anastomosis, the Authors relate personal technique of reconstruction with extramucosal continuous suture, one-layer, with synthetic slow absorbable one-filament (PDS). In conclusion, the Authors declare that the introduction of the mechanical suture has certainly influenced the development of the new therapeutic solutions and has allowed intestinal anastomosis in sites of difficult access (abdominal esophagus, low rectum), but they think that the surgeon must to learn to know when is useless or neoplastic mechanical suture and he can realize manually the same anastomosis with quickness and safety.