Objective There have been many techniques proposed for the reconstruction of pancreatic digestive continuity to prevent fistula (PF) formation, but this is still highly debated. We carried out a systematic review and meta- analysis to determine the effectiveness of methods of anastomosis after pancreaticoduodenectomy (PD). Methods A full literature search was conducted in the Cochrane Controlled Trials Register Databases, Medline, et al.Randomized controlled trials(RCTs) were considered for inclusion. Analysis was carried out using Revman software. Results In all, 10 RCTs including a total of 1 408 patients were included, the pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) groups, duct to mucosa PJ and PJ, binding PJ and PJ, pancreatic duct without anastomosis PJ and PJ. The meta-analysis showed that the PF, postoperative complications, biliary fistula, mortality, re-operation and hospital stay were not statistically different among four methods(P>0.05).Conclusions No ideal technique of pancreatic reconstruction after PD is found to be applicable to all kinds of pancreatic remnants in this systematic review and meta-analysis.