surgical recurrence compared to handsewn anastomoses was observed [72, 73]. Usually, S-S is a wider anastomosis compared to an E-E anastomosis, less resis­tance suggests S-S would lead to less complication and postoperative recurrence. This hypotheses was supported for short term outcomes in four meta-analyses, as S-S anastomosis reduced overall postoperative complications and anastomotic leak­age rate, compared to handsewn E-E anastomosis [58, 73–75]. One of the meta­analyses specically compared stapled isoperistaltic S-S versus handsewn E-E and reported superiority of the S-S anastomosis for short term-outcomes [75]. This has not been conrmed in RCT’s, reporting similar surgical outcomes, e.g. anastomotic leakage rates, for stapled S-S anastomosis and handsewn E-E anastomosis [76, 77]. Concerning long-term effects, it is hypothesized that a higher resistance to the fecal stream is associated with a higher recurrence rate. Probably all four techniques have a different resistance to the fecal stream, either due to the width of the anastomosis or due to the anti- or isoperistaltic direction. Therefore, the existing evidence directs the surgeon towards using a wide anastomosis of which the aniso- and isoperistaltic anastomosis are the best in this respect [74, 75]. The disadvantages of anisoperital­tic anastomoses are difcult intubation by colonoscopy, and of isoperistaltic anasto­moses the creation of a blind loop on both sides of the anastomosis. Taken these studies together with the practical consideration, aniso- or isoperistaltic stapled S-S anastomosis are the preferred types of anastomosis.