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Open Access Highly Accessed Research article

Single- versus two- layer intestinal anastomosis: a meta-analysis of randomized controlled trials

Satoru Shikata12, Hisakazu Yamagishi1, Yoshinori Taji2, Toshihiko Shimada3 and Yoshinori Noguchi3*

Author Affiliations

1 Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

2 Department of Clinical Epidemiology, Kyoto University, Kyoto, Japan

3 Department of Medicine, Fujita Health University School of Medicine, Aichi, Japan

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BMC Surgery 2006, 6:2  doi:10.1186/1471-2482-6-2

Published: 27 January 2006



To compare single- with two- layer intestinal anastomosis after intestinal resection: a meta-analysis of randomized controlled trials.


Randomized controlled trials comparing single- with two-layer intestinal anastomosis were identified using a systematic search of Medline, Embase and the Cochrane Library Databases covering articles published from 1966 to 2004. Outcome of primary interest was postoperative leak. A risk ratio for trial outcomes and weighted pooled estimates for data were calculated. A fixed-effect model weighted using Mantel-Haenszel methods and a random-effect model using DerSimonian-Laird methods were employed.


Six trials were analyzed, comprising 670 participants (single-layer group, n = 299; two-layer group, n = 371). Data on leaks were available from all included studies. Combined risk ratio using DerSimonian-Laird methods was 0.91 (95% CI = 0.49 to 1.69), and indicated no significant difference. Inter-study heterogeneity was significant (χ2 = 10.5, d.f. = 5, p = 0.06).


No evidence was found that two-layer intestinal anastomosis leads to fewer post-operative leaks than single layer. Considering duration of the anastomosis procedure and medical expenses, single-layer intestinal anastomosis appears to represent the optimal choice for most surgical situations.