Comparing Stapled and Hand-Sutured Colorectal Anastomoses: A Systematic Review and Meta-Analysis of Observational Cohorts Assessing Short- and Long-Term Complications

This systematic review and meta-analysis was conducted to compare outcomes after stapled and hand-sewn colorectal anastomoses. The study was undertaken because complication patterns, such as anastomotic leak, surgical site infection (SSI), length of stay (LOS), and mortality, remain debated and may vary by technique. The objective was to evaluate whether either method showed a clear advantage across early and late outcomes. A systematic search of PubMed, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing & Allied Health Literature), and Google Scholar was completed for studies published from January 2015 to June 2025. Only observational studies that compared stapled with hand-sewn anastomosis and reported at least three clinical outcomes were included. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Although the review focused primarily on colorectal procedures, select small-bowel cohorts were included when outcomes were reported separately by technique. Six observational studies met eligibility criteria. Random-effects modelling was planned, and heterogeneity was assessed using the I² statistic, although limited numerical reporting in the source studies restricted full quantitative synthesis. Across studies, anastomotic leak, SSI, LOS, and mortality appeared similar between stapled and hand-sewn groups, and no consistent statistical advantage was described for either method. Stapled anastomosis often required less operative time, although this did not appear to change complication rates. Study heterogeneity was influenced by differences in surgical context, such as elective, emergency, or Crohn disease cases, yet sensitivity assessment suggested that these variations did not alter the overall direction of findings. The evidence suggests that both techniques remain safe options when used appropriately, though stronger conclusions would require more detailed and standardized outcome reporting.