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To evaluate Roux-en-Y and Billroth II reconstruction following pancreaticoduodenectomy (PD). PubMed, Embase, the Cochrane Library, and the Web of Science were searched to identify randomized controlled trials (RCTs) and controlled clinical trials that compared Roux-en-Y and Billroth II reconstruction following PD up to December 2019. RevMan 5.3 software was used for the statistical analysis. Four RCTs and five controlled clinical trials were included, with a total of 1,072 patients (500 and 572 patients in the Roux-en-Y and Billroth II