A Systematic Review of Single-Layer Versus Double-Layer Intestinal Anastomosis: Is One Better?

To perform a systematic review of randomized controlled trials comparing outcomes from handsewn single-layer and double-layer intestinal anastomosis in adults. A literature search was conducted using PubMed, SCOPUS, and Web of Science databases for studies published up to September 14, 2023 using the following keyword search query: ((one) OR (single)) AND ((two) OR (double)) AND (layer) AND ((anastomoses) OR (anastomosis)). In seven of the eight studies, there was no significant difference in anastomotic leakage rate. In one of the eight studies, Moeen et al., double-layer anastomosis was associated with a significantly higher anastomotic leakage rate than single-layer anastomosis (5/100 versus 15/100, P = 0.018). Time to complete single-layer anastomosis was shorter than double-layer anastomosis. Single-layer and double-layer intestinal anastomosis have similar rates of anastomotic leak, mortality, and hospital stay in adults, with single-layer intestinal anastomosis having the benefit of shorter time to complete.