Single-stapled versus double-stapled colorectal anastomosis after anterior resection: Systematic review and meta-analysis of short-term and functional outcomes

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.