Single-stapled versus non-single-stapled colorectal anastomosis in minimally invasive anterior resections: a systematic review and meta-analysis

Anastomotic leak remains a major cause of morbidity after anterior resection for rectal cancer. The single-stapled technique (SST) has been proposed to eliminate crossover of intersecting staple lines in conventional non-single-stapled techniques (NSST). However, evidence comparing the two approaches in minimally invasive anterior resections remains limited. A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines (PROSPERO CRD420251053461). Randomised and observational studies comparing SST versus NSST in adult minimally invasive anterior resections were included. Primary outcomes were anastomotic leak and length of hospital stay. Secondary outcomes included operative time, postoperative morbidity (Clavien–Dindo ≥ III), and mortality. Random-effects models were used to pool effect estimates. Five observational studies ( n = 1647; SST = 587, NSST = 1060) met inclusion criteria. Pooled analysis demonstrated that SST significantly reduced anastomotic leak rates compared with NSST (OR 0.43; 95% CI 0.26–0.70; p = 0.0007; I 2 = 23%). Length of stay was shorter with SST (SMD − 0.43; 95% CI − 0.75 to − 0.11; p = 0.008; I 2 = 88%). Operative time, blood transfusion requirements, and major postoperative complications did not differ significantly. Mortality was zero in all reporting studies. Single-stapled anastomosis in minimally invasive anterior resection is associated with a lower pooled risk of anastomotic leak compared with non-single-stapled techniques. Despite heterogeneity in secondary outcomes, SST appears to be a promising technical refinement; however, randomised trials are required before routine adoption.