Single-stapled versus double-stapled colorectal anastomosis after anterior resection: Systematic review and meta-analysis of short-term and functional outcomes
In brief
Single-stapled colorectal anastomosis does not reduce leak risk versus double-stapled
A meta-analysis of 13 studies involving 2,537 patients found no statistically significant difference in anastomotic leak, major complications, or stricture when comparing single-stapled with the standard double-stapled technique after anterior rectal resection. The single-stapled method appears safe but offers no clear clinical advantage, and larger trials are needed to confirm any benefit.
- Journal
- Surgery (Q1)
- Published
- 26 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Antonio Luberto, Fabio Carbone, Daniela Rega, Massimiliano Di Marzo, Caterina Foppa, Antonino Spinelli, et al.
- PMID
- 42759190
- DOI
- 10.1016/j.surg.2026.110558
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 20 September 2026): Single vs double stapled anastomosis meta-analysis
- Picked for Gastrointestinal and Colorectal Surgery (paper of the day, 20 September 2026): Evidence from Surgery
Abstract
BACKGROUND: The double-stapled anastomosis technique is widely considered the standard approach for colorectal anastomosis after anterior rectal resection. Recently, the single-stapled anastomosis technique has gained attention because it may reduce potential weak points that could contribute to anastomotic leakage by avoiding stapler line intersections. This systematic review and meta-analysis aim to compare surgical and functional outcomes between single-stapled anastomosis and double-stapled anastomosis. METHODS: A systematic literature search of PubMed, EMBASE-Medline, and the Cochrane Library was performed in November 2025 to identify studies comparing single-stapled anastomosis and double-stapled anastomosis after anterior rectal resection. The end points were postoperative complications and major low anterior resection syndrome. A random-effect meta-analysis was performed to synthesize the results. RESULTS: Thirteen studies met the inclusion criteria and were included in the meta-analysis (9 cohort studies, 1 matched case-control study, and 3 randomized controlled trials). Indications for anterior rectal resection included colorectal cancer, diverticular disease, inflammatory bowel disease, and endometriosis. Overall, 2,537 patients were analyzed. Single-stapled anastomosis was associated with a nonsignificant reduction in the risk of anastomotic leak (risk ratio, 0.77; 95% confidence interval, 0.46-1.31; I2 = 49.3%), major postoperative complications (risk ratio, 0.67; 95% confidence interval, 0.37-1.20; I2 = 4.1%), and anastomotic stricture (risk ratio, 0.19; 95% confidence interval, 0.02-1.92) compared with double-stapled anastomosis. The major low anterior resection syndrome risk was similar across techniques (risk ratio, 0.94; 95% confidence interval, 0.39-2.30). CONCLUSION: Single-stapled anastomosis appears to be a safe alternative to the double-stapled anastomosis technique after restorative anterior rectal resection. Although no statistically significant differences were observed in anastomotic leak, postoperative complications, anastomotic stricture, and major low anterior resection syndrome risk, single-stapled anastomosis may represent a technically appealing option. Further large multicenter randomized trials are required.
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.