Objective: To systematically evaluate the safety and efficacy of pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) for pancreatico-digestive anastomosis after pancreaticoduodenectomy (PD). Methods: The prospective randomized controlled trials concerning application of PG and PJ in PD were collected by searching available national and international databases. Data were extracted by two independent reviewers, and the methodological quality of the included studies was evaluated according to the Cochrane handbook 5.1. Meta-analysis was performed using Manager 5.2 software. Results: A total of 7 studies were included involving 1 121 patients, with 562 cases in PG group and 559 cases in PJ group. Meta-analysis indicated that PG group was superior to PJ group with regard to the incidence of pancreatic fistula (OR=0.60, 95% CI=0.44–0.82, P=0.001), biliary fistula (OR=0.42, 95% CI=0.18–0.93, P=0.03) and intra-abdominal collection (OR=0.50, 95% CI=0.34–0.74, P=0.0005), while there was no significant difference between the two groups in respect to the incidence of delayed gastric emptying (OR=0.98, 95% CI=0.53–1.82, P=0.95) and postoperative intra-abdominal hemorrhage (OR=1.29, 95% CI=0.95–1.96, P=0.24), as well as the reoperation rate (OR=0.96, 95% CI=0.61–1.52, P=0.87) and mortality (OR=0.82, 95% CI=0.43–1.58, P=0.56). Conclusion: PG is superior to PJ in reducing the incidence of pancreatic fistula, biliary fistula and intra-abdominal collection, however, the safety and long-term efficacy of the two procedures still need further verification.