A Cochrane review included 7 studies with a total of 1125 subjects. Stapled anastomosis was associated with significantly fewer anastomotic leaks compared with handsewn (S=11/441, HS=42/684, OR 0.48 [0.24, 0.95]). For the sub-group of 825 cancer patients in four studies, stapled anastomosis led to significant fewer anastomotic leaks (S=4/300, HS=35/525, OR 0.28 95% Cl 0.10 to 0.75). In subgroup analysis of non-cancer patients (3 studies, 264 patients) There were no differences for any reported outcomes. All other outcomes: stricture, anastomotic haemorrhage, anastomotic time, re-operation, mortality, intra-abdominal abscess, wound infection and length of stay showed no significant difference.