Purpose: The method of anastomotic technique for ileal and colonic resections has been a subject of debate, with no clear consensus as to whether handsewn or stapled techniques are superior in terms of anastomotic outcomes in elective settings. However, elective settings are not with the complexities of trauma physiology, where there are unique perturbances to important processes such as immune system function, coagulation and wound healing. This meta-analysis compares the risk of anastomotic complications in trauma patients requiring stapled or handsewn anastomosis. Methodology: A computer-assisted search of Medline, Embase and Cochrane Central databases was performed. Comparative studies evaluating stapled versus handsewn gastrointestinal anastomoses in trauma patients were included. All anastomoses involving small or large intestine were eligible. Rectal anastomoses were excluded. Outcomes evaluated were anastomotic leak (AL) and a composite anastomotic complication endpoint consisting of AL, enterocutaneous fistula and deep abdominal abscess. Results: Eight studies involving 931 patients were included and of these, data from 790 patients were available for analysis. There was no significant difference identified for AL between the two groups (OR = 0.77; 95% CI 0.24 to 2.45; p=0.66). There was no significant improvement in composite anastomotic complication in the stapled anastomosis group (OR = 1.05; 95% CI 0.53 to 2.09; p=0.90). Conclusion: This meta-analysis demonstrates no improvement in anastomotic leak outcomes with the approach to anastomosis. Stapled anastomosis was associated with a pooled reduction in the odds of composite anastomotic complication in trauma patients. However, the foundation for these results is based on lower quality studies.