OBJECTIVES:  Ileocolic anastomoses are commonly performed for right-sided colon cancer and Crohn’s disease. Anastomotic leak complications are a significant source of patient morbidity and mortality and have a major impact on health care costs. The objective of this analysis was to compare anastomotic leak rates following ileocolic anastomoses performed using mechanical stapling and hand-sewn suture techniques. METHODS:  Pubmed, Embase, Cochrane Library and trial registries were searched for randomized controlled trials comparing hand-sewn and stapled ileocolic anastomoses published between 1990 and December 2013. The odds ratio (OR) for overall anastomotic leak rate was calculated and then weighted and pooled in a meta-analysis with Mantel-Haenszel fixed-effect modeling with Chi square test for heterogeneity. RESULTS: Eight studies with a total of 1,172 patients were included. Two studies were from Germany, 2 from Scotland, 1 from France, 1 from Japan, 1 from US and 1 was a global study with patients from US, UK and Canada. The median and average sample sizes across studies were 112 and 149 patients, respectively. Three studies were for Crohn’s disease, 3 were for colorectal cancer and 2 were for other diagnoses. There were 11 (2.31%) anastomotic leaks reported in 457 patients in the mechanically stapled group, and 44 (6.15%) leaks in 715 patients in the hand-sewn (sutures) group. At study level, the median leak rates in stapled and hand-sewn groups were 0.40% and 3.95%, respectively. Overall, the odds of anastomotic leaks were reduced to less than half with mechanical stapling compared to hand sewn techniques (pooled OR = 0.46; 95% CI = 0.24 to 0.89; p = 0.02).  CONCLUSIONS: This meta-analysis of randomized controlled trials comparing hand-sewn with stapled ileocolic anastomoses demonstrates a significantly lower rate of anastomotic leakage with mechanical stapling – which has potential to improve patient outcomes, lower re-operation rates and lower costs.