Background: Intestinal anastomosis is a critical surgical procedure performed to restore the continuity of the gastrointestinal tract after resection. This study aimed to compare the outcomes of single-layered versus double-layered intestinal anastomosis in terms of operative time, postoperative complications, hospital stay, readmission rates, and overall morbidity and mortality.Material and Methods: This randomized controlled trial was conducted at a tertiary care hospital after obtaining ethical approval. A total of 120 patients requiring intestinal anastomosis for various indications were randomly assigned into two groups: Group A (single-layered anastomosis, n=60) and Group B (double-layered anastomosis, n=60). Standardized anastomotic techniques were performed under general anesthesia. Postoperative monitoring included anastomotic leakage, wound infection, ileus, stricture formation, mortality, and hospital stay. Data were analyzed using SPSS, with statistical significance set at p<0.05.Results: The mean operative time was significantly lower in the single-layered anastomosis group (82.45 ± 12.56 minutes) compared to the double-layered group (96.78 ± 15.32 minutes, p<0.001). Postoperative complications, including anastomotic leakage (8.33% vs. 6.67%, p=0.72), wound infection (11.67% vs. 15.00%, p=0.59), ileus (10.00% vs. 13.33%, p=0.57), and mortality (1.67% vs. 3.33%, p=0.57), were comparable between the two groups. The mean hospital stay was slightly shorter in the single-layered group (7.45 ± 2.12 days) than in the double-layered group (8.02 ± 2.45 days, p=0.48), though not statistically significant. Readmission within 30 days was observed in 6.67% of the single-layered group and 8.33% of the double-layered group (p=0.73). Overall morbidity was similar between the two groups (23.33% vs. 26.67%, p=0.67).Conclusion: Single-layered anastomosis significantly reduces operative time without increasing the risk of anastomotic leakage, wound infection, or overall morbidity and mortality. Given its efficiency and comparable safety profile, the single-layered approach may be preferable in clinical settings where minimizing surgical duration and optimizing resource utilization are priorities.