Abstract： AIM To systematically evaluate the efficacy and safety of ablation and surgery in the treatment of primary aldosteronism.METHODS PubMed,EMbase,the Cochrane Library(Issue 7,2022),Web of Science,China National Knowledge Infrastructure(CNKI),and Wanfang Database were searched for literatures which evaluated the efficacy and safety of ablation and surgery in the treatment of primary aldosteronism.The retrieval time limit was from the establishment of the database to July 2022.Two reviewers independently screened the literature,extracted the data and evaluated the risk of bias of the included studies.Newcastle-ottawascale(NOS)was used to evaluate the quality of the studies and Stata 12.0 software was used for meta-analysis.Weighted mean difference(WMD)and 95%CI were used for measurement data,and odds ratio(OR)and 95%CI were used for enumeration data.RESULTS A total of 5 related studies were selected for inclusion in this study,including 204 study subjects.The results showed that the ablation group had a lower degree of decrease in diastolic blood pressure compared to the surgical group(WMD=5.19,95%CI:0.96-9.43),however,it had a shorter hospital stay(OR=1.6,95%CI:-2.37～-0.83),both P<0.05.There was no significant difference in other indicators between the two groups,including systolic blood pressure,drug use,blood potassium,surgical success rate,surgical time,intraoperative bleeding,hypertensive crisis,and total complications.The Funnel funnel plot showed no publication bias in the 5 studies included regarding surgical success rates,and the use of Begg's and Egger's tests also indicated no publication bias(P values 0.81 and 0.80,respectively).CONCLUSION The safety of ablative and surgical procedures for primary hyperaldosteronism is the same,surgical procedure had better diastolic blood pressure control,but ablative procedures shorten hospital stay.