{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:11:51Z","timestamp":1787800311253,"version":"build-2784847793"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n The single-stapling technique (SST) is an alternative to the conventional double-stapling technique (DST), particularly in low rectal surgery. This systematic review and meta-analysis compared anastomotic leak (AL) between SST and DST.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A systematic review of the PubMed\/MEDLINE, Google Scholar\u00ae, and Scopus databases was conducted in accordance with PRISMA guidelines from inception through December 2025. The primary outcome of interest was AL. A random-effects meta-analysis was used to compare AL, blood loss, operative time, and length of hospital stay between SST and DST. Risk ratios (RRs) were calculated for dichotomous outcomes and mean differences or standardized mean differences were calculated for continuous outcomes. Sensitivity and subgroup analyses were conducted according to surgical approach. Risk of bias was assessed, and the certainty of the evidence for AL was evaluated using the GRADE framework.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 448 articles screened, 14 were included (2 randomized, 12 observational studies), comprising 1326 patients in the SST group and 1720 in the DST group. SST was associated with a significantly lower risk of AL than DST (RR 0.61; 95% confidence interval 0.42 to 0.90; P = 0.012), with moderate heterogeneity. Sensitivity analysis excluding studies with zero events yielded consistent results. Subgroup analyses showed no difference in AL for open intracorporeal SST compared with DST, a trend toward benefit with minimally invasive intracorporeal SST compared with DST, and a pronounced reduction in AL with transanal SST compared with DST.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Although the causes of AL are multifactorial, with respect to the stapling technique, SST was associated with a lower risk of AL than DST, and this effect was primarily driven by transanal SST. However, the certainty of evidence is low, and ongoing prospective studies will better define the role of SST.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag078","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T11:52:24Z","timestamp":1778673144000},"source":"Crossref","is-referenced-by-count":1,"title":["Single-stapling\n versus<\/i>\n double-stapling technique for rectal anastomosis\u2014meta-analysis"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7691-6355","authenticated-orcid":false,"given":"Dimitrios","family":"Kehagias","sequence":"first","affiliation":[{"name":"John Goligher Colorectal Unit, Leeds Teaching Hospitals NHS Trust , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalampos","family":"Lampropoulos","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, St Andrew\u2019s General Hospital of Patras , Patras ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Kehagias","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Patras , Patras ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Jayne","sequence":"additional","affiliation":[{"name":"John Goligher Colorectal Unit, Leeds Teaching Hospitals NHS Trust , Leeds ,","place":["UK"]},{"name":"Leeds Institute of Medical Research, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Tiernan","sequence":"additional","affiliation":[{"name":"John Goligher Colorectal Unit, Leeds Teaching Hospitals NHS Trust , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"2026081701221044000_zrag078-B1","first-page":"270","article-title":"The double-staple technique in colorectal anastomoses: a critical review","volume":"58","author":"Baran","year":"1992","journal-title":"Am Surg"},{"key":"2026081701221044000_zrag078-B2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/BF01647658","article-title":"Double versus single stapling technique in rectal anastomosis","volume":"7","author":"Bozzetti","year":"1992","journal-title":"Int J Colorectal Dis"},{"key":"2026081701221044000_zrag078-B3","first-page":"710","article-title":"An improved technique for low anterior resection of the rectum using the EEA stapler","volume":"88","author":"Knight","year":"1980","journal-title":"Surgery"},{"key":"2026081701221044000_zrag078-B4","doi-asserted-by":"crossref","DOI":"10.1016\/j.suronc.2022.101708","article-title":"Anastomotic leakage in colorectal cancer surgery","volume":"40","author":"Chiarello","year":"2022","journal-title":"Surg Oncol"},{"key":"2026081701221044000_zrag078-B5","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1245\/s10434-014-4187-3","article-title":"Anastomotic leakage is associated with impaired overall and disease-free survival after curative rectal cancer resection: a propensity score analysis","volume":"22","author":"Kulu","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"2026081701221044000_zrag078-B6","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/DCR.0000000000003478","article-title":"Impact of anastomotic leakage after colorectal cancer surgery on quality of life: a systematic review","volume":"68","author":"Gielen","year":"2025","journal-title":"Dis Colon Rectum"},{"key":"2026081701221044000_zrag078-B7","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.surg.2022.02.019","article-title":"Comprehensive literature review of the outcome, modifications, and alternatives to double-stapled low pelvic colorectal anastomosis","volume":"172","author":"Emile","year":"2022","journal-title":"Surgery"},{"key":"2026081701221044000_zrag078-B8","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1055\/s-0042-1756510","article-title":"The colorectal anastomosis: a timeless challenge","volume":"36","author":"Gaidarski","year":"2023","journal-title":"Clin Colon Rectal Surg"},{"key":"2026081701221044000_zrag078-B9","doi-asserted-by":"crossref","first-page":"2988","DOI":"10.1007\/s00464-014-3564-0","article-title":"Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis","volume":"28","author":"Kawada","year":"2014","journal-title":"Surg Endosc"},{"key":"2026081701221044000_zrag078-B10","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/codi.14376","article-title":"An international multicentre prospective audit of elective rectal cancer surgery; 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