SP 11.05 Single-Stapled Versus Non-Single Stapled Technique of Colorectal Anastomosis in Minimally Invasive Anterior Resections – A Systematic Review and Meta-Analysis
Shubham Jain, Radi Abweni, Maria Iacob, Roland Labinoti, Arshad MalikAbstract
Background
Anastomotic leak remains a major cause of morbidity after anterior resection for rectal cancer. The single-stapled technique (SST) has been proposed to minimize ischemic “dog-ears” created by intersecting staple lines in conventional non-single-stapled techniques (NSST). However, evidence comparing the two approaches in minimally invasive anterior resections remains limited.
Methods
A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines (PROSPERO CRD420251053461). Randomized 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.
Results
Five observational studies (n = 1370; SST = 437, NSST = 933) met inclusion criteria. Pooled analysis demonstrated that SST significantly reduced anastomotic leak rates compared with NSST (OR 0.50; 95% CI 0.30–0.82; p = 0.006; I² = 10%). Length of stay was shorter with SST (SMD −0.52; 95% CI −0.87 to −0.18; p = 0.003; I² = 87%). Operative time, blood transfusion requirements, and major postoperative complications did not differ significantly. Mortality was zero in all reporting studies.
Conclusions
SST appears to halve the risk of anastomotic leak compared to NSST in minimally invasive anterior resections, with a possible reduction in hospital stay. While promising, these findings derive from non-randomized evidence at moderate to high risk of bias. Large multicentre randomized controlled trials with standardized leak definitions and perioperative protocols are warranted before routine adoption.