Background: The use of somatostatin and its analogues in pancreatic surgery to reduce the incidence of complications is still under debate. The objective of this systematic review and meta-analysis is to quantitatively assess the efficacy of the perioperative use of somatostatin in pancreatic surgery. Methods: A systematic literature search according to Cochrane collaboration standards (Medline, Embase, Cochrane library, conference reports) was performed. Randomized controlled trials (RCTs) comparing the perioperative treatment with or without use of somatostatin were eligible. A critical appraisal of included studies was performed using a standardized form to extract and evaluate pre-specified parameters and methodological quality. Two reviewers independently extracted quantitative data on peri- and postoperative morbidity and mortality. Main outcome measures were overall postoperative complications, pancreatic associated complications, pancreatic fistula, mortality, and hospital stay. Further analyses were performed for pre-specified subgroups of pancreatic cancer, chronic pancreatitis, pancreaticoduodenectomy, distal pancreatectomy, somatostatin s.c. , and somatostatin i.v. Summarized treatment effect was computed in a meta-analysis (ReviewManager software 4.2.8) using the random effects model. Thus, pooled effect estimates were presented as odds ratios (OR) and the corresponding 95% confidence intervals (CI). Results: A total of 16 RCTs including overall 2153 patients, referring to the use of somatostatin or its analogues in pancreatic surgery, met the inclusion criteria. Meta-analysis of somatostatin versus control revealed a significant reduction of overall postoperative complications in the somatostatin group (OR .57, CI .39-.81; P=.002). Accordingly, pancreatic associated complications (OR .49, 95% CI .33-.73, P=.0004) and the rate of pancreatic fistula (OR .56, 95% CI .39-.80, P=.001) were reduced significantly in the treatment group. There were no differences in mortality (OR 1.07, 95% CI .66-1.74; P=.77) and hospital stay (Weighted Mean Difference -1.85, CI -6.03-2.33; P=.39). Similar results were determined in subgroup analyses of patients with pancreatic cancer or chronic pancreatitis, pancreaticoduodenectomy or distal pancreatectomy, and application of somatostatin s.c. or i.v. Conclusion: According to the results, a beneficial effect of the use of somatostatin in pancreatic surgery in terms of lower mortality rate or shortened hospital stay could not be demonstrated. However, somatostatin significantly reduced the rate of overall and pancreas specific postoperative complications, in particular also the occurrence of pancreatic fistula.