ObjectiveTo compare the safety and efficacy of powered anastomosis versus mechanical anastomosis in gastrointestinal surgery. MethodsComputerized searches were conducted in PubMed, EMbase, Web of Science, CNKI, and CBM databases to collect studies comparing the safety and efficacy of powered versus mechanical anastomosis in gastrointestinal surgery. The search period was from the inception of each database to March 2025. Literature was screened according to inclusion and exclusion criteria, data were extracted, and the risk of bias was assessed. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using the Metan package in Stata/MP 17.0 software. ResultsA total of 15 observational studies (13 retrospective and 2 prospective) involving 21,424 patients were finally included, with 9 823 patients in the experimental group (powered anastomosis) and 11 601 patients in the control group (mechanical anastomosis). The NOS scores of all included studies were ≥5 points. Meta-analysis results showed that, compared to the mechanical anastomosis group, the powered anastomosis group had significantly lower incidence rates of anastomotic leakage [RR=0.60, 95%CI (0.37, 0.96), P=0.031], postoperative complications [RR=0.68, 95%CI (0.53, 0.86), P<0.01], intraoperative bleeding rate [RR=0.29, 95%CI (0.15, 0.56), P<0.01], and 30-day readmission rate [RR=0.62, 95%CI (0.39, 0.97), P<0.05]. No statistically significant differences were found in anastomotic stenosis [RR=0.53, 95%CI (0.18, 1.57), P=0.25], intraoperative blood loss [SMD=−0.03, 95%CI (−0.15, 0.08), P=0.57], operation time [SMD=−0.00, 95%CI (−0.08, 0.07), P=0.90], or postoperative hospital stay [SMD=−0.05, 95%CI (−0.13, 0.02), P=0.15]. ConclusionIn gastrointestinal surgery, powered anastomosis may offer potential advantages over traditional mechanical anastomosis in improving the aforementioned safety and efficacy outcomes.