Single-stapling versus double-stapling technique for rectal anastomosis-meta-analysis.

Area of Science:

• Colorectal surgery
• Surgical techniques
• Gastrointestinal oncology

Background:

• The double-stapling technique (DST) is standard for low rectal surgery.
• The single-stapling technique (SST) offers an alternative.
• Anastomotic leak (AL) is a significant complication in rectal surgery.

Purpose of the Study:

• To compare the risk of anastomotic leak (AL) between single-stapling technique (SST) and double-stapling technique (DST).
• To evaluate secondary outcomes including blood loss, operative time, and length of hospital stay.
• To assess the impact of surgical approach on AL rates.

Main Methods:

• Systematic review and random-effects meta-analysis of PubMed/MEDLINE, Google Scholar®, and Scopus databases.
• Included 14 studies (2 RCTs, 12 observational) with 1326 patients in SST group and 1720 in DST group.
• Assessed risk of bias and certainty of evidence using GRADE framework.

Main Results:

• SST was associated with a significantly lower risk of AL than DST (RR 0.61; P=0.012).
• Transanal SST showed a pronounced reduction in AL compared to DST.
• Minimally invasive intracorporeal SST showed a trend toward benefit over DST.

Conclusions:

• Single-stapling technique (SST) is associated with a reduced risk of anastomotic leak (AL) compared to double-stapling technique (DST).
• The benefit of SST in reducing AL is primarily driven by the transanal approach.
• Further prospective studies are needed to confirm findings due to low certainty of evidence.