Objective To systematically evaluate the efficacy and safety of lumbo-peritoneal shunt (LPS) and ventriculo-peritoneal shunt (VPS) for the treatment of communicating hydrocephalus.Methods Databases such as PubMed, Cochrane Library, EMbase, CNKI, WanFang Data, CBM and VIP were searched to collect randomized controlled trials or cohort studies on LPS versus VPS for the treatment of communicating hydrocephalus that were published from May 1990 to May 2016. A meta-analysis was conducted using RevMan 5.3 software.Results Thirteen articles were included in the study, with a total of 1321 patients. The meta-analysis showed that there was no significant difference between the LPS group and the VPS group in the effectiveness of the surgical treatment of communicating hydrocephalus[RR=1.13, 95%CI (1.00, 1.28), P=0.06]. However, the success rate of LPS was significantly higher than that of VPS[RR=1.14, 95%CI (1.05, 1.23), P=0.0010]. Compared with those treated with VPS, the patients treated with LPS had significantly lower incidence rates of postoperative bleeding complications[RR=0.35, 95%CI (0.15, 0.81), P=0.01], infectious complications[RR=0.29, 95% CI (0.16, 0.51), P<0.0001], and shunt tube-related complications[RR=0.38, 95%CI (0.27, 0.52), P<0.00001]. The incidence of postoperative shunt abnormalities showed no significant difference between the two operations[RR=0.79, 95%CI(0.41, 1.53), P=0.49].Conclusions The results of this study suggest that LPS and VPS are equivalent in the treatment of communicating hydrocephalus. However, the success rate of LPS is higher, and the incidence of postoperative complications is lower after LPS. Overall, LPS is superior to VPS.