Anastomotic insufficiency still remains the most dreaded complication following digestive surgery. The surgeon's understanding of the mechanisms underlying anastomotic healing and the possible weak points are just as important as a correct anastomotic technique. Intestinal anastomotic healing is a complex, cell-mediated process which aims at restoring bowel wall continuity. The early stages of anastomotic healing are most susceptible to various sources of irritation, which is reflected by the likelihood of early anastomotic insufficiency. In our opinion, the focus of future research should shift from primarily examining pathogenetic factors to a more cellular and molecular level. A better comprehension of the anastomotic healing process might thus promote the development of new diagnostic predictive and therapeutic methods.