Objective To determine the efficacy and safety for low-pressure pneumoperitoneum (LP) in laparoscopic cholecystectomy (LC) from randomized controlled trials (RCTs). Methods A fully recursive literature search was conducted in Cochrane Library, MEDLINE, EMBASE, ISI databases and CBM, VIP, CNKI and Wan Fang database in any language. RCTs between Jan, 1987 and Dec, 2009 of LP in LC were considered for inclusion. Statistic analyses were carried out using RevMan 5.0 software. Results Five hundred and eighteen patients in 7 randomized controlled trials (RCTs) were included. The meta-analysis showed that incidence of shoulder tip pain was lower in the LP group (RR was 0.50, 95%CI 0.37 to 0.68); length of postoperative days were shorter in the LP group (WMD was -0.13, 95%CI -0.23 to -0.02); operative time and complications were similar in both groups (WMD was 1.54, 95%CI -0.85 to 3.76; RR was 0.84, 95%CI 0.46 to 1.54, respectively). Conclusions LP was more effective than SP in selective LC without increasing complications.