Stapled Versus Hand-Sewn Intestinal Anastomosis in Pediatric Surgery: A Systematic Review and Meta-Analysis
In brief
Stapled intestinal anastomosis cuts operative time by 19 minutes and speeds feeding
In a meta-analysis of 11 studies involving 903 children, stapled anastomosis shortened surgery by about 19 minutes and allowed oral intake roughly two days sooner than hand-sewn techniques, without increasing leaks, strictures, reoperations, or hospital stay. The data support selective use of staplers when anatomy permits, but larger randomized trials are still needed.
- Journal
- Journal of pediatric surgery (Q1)
- Published
- 16 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Muhammad Meeran Saleem, Areeba Ahsan, Abia Shariq, Marium Amjad, Muhammad Affan Abid, Shanezehra Siddiqui, et al.
- PMID
- 42462999
- DOI
- 10.1016/j.jpedsurg.2026.163305
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 19 July 2026): High-quality evidence in a top journal
- Picked for Pediatrics and Child Health (top studies of the week, 19 July 2026): Stapled vs hand‑sewn intestinal anastomosis in pediatric surgery
- Picked for Surgery (top studies of the week, 19 July 2026).
Abstract
BACKGROUND: Intestinal anastomosis is a core procedure in pediatric gastrointestinal surgery, performed for conditions such as necrotizing enterocolitis, intestinal atresia, Hirschsprung's disease, and inflammatory bowel disease. Although stapled anastomosis (SA) may improve operative efficiency, its safety and effectiveness compared with hand-sewn anastomosis (HA) in children remain uncertain. This meta-analysis compared clinical outcomes of SA and HA in pediatric patients. METHODS: The study followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251177257). A systematic search of PubMed, Dimensions, and the Cochrane Library was conducted through June 2025. Studies including children under 7 years undergoing intestinal SA or HA were eligible. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment using ROB 2 and ROBINS-I tools. Statistical analysis was conducted using Comprehensive Meta-Analysis software (v3) with a random-effects model. RESULTS: Eleven studies involving 903 patients met inclusion criteria, including two randomized controlled trials. Of these, 333 patients underwent SA and 570 underwent HA. SA was associated with significantly shorter operative time (mean difference [MD] = -19.26 min; 95% CI: -24.24 to -14.28; p < 0.001) and earlier initiation of oral feeding (MD = -2.32 days; 95% CI: -3.78 to -0.86; p = 0.002). No significant differences were found in anastomotic leakage, stricture formation, reoperation rate, or length of hospital stay. CONCLUSIONS: Stapled anastomosis appears as safe as hand-sewn techniques in pediatric intestinal surgery while offering shorter operative duration and faster postoperative feeding recovery. Selective use of stapled techniques is supported when anatomically feasible, though further multicenter randomized trials are needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.