Background: The aim of the Study Centre of the German Surgical Society (SDGC) is to design, conduct and analyze multicentre randomized controlled trials on the basis of systematic reviews and meta-analyses. The development of a specialized surgical systematic review unit will be presented in the following. Methods: A systematic review unit was established consisting of a surgeon (MKD) trained at the German Cochrane Centre, a biostatistician (KJ), an information retrieval specialist (KG) and three surgical residents (PC, NNR, MNW). Prior to conducting a systematic review, feasibility and necessity is discussed at a bi-monthly meeting of all members of the SDGC. Systematic reviews and meta-analyses of the SDGC are conducted according to the principles and guidelines of the Cochrane Collaboration. In addition, methodological studies are performed dealing with the problem of different trial designs and the resulting heterogeneity in surgical trials. A close partnership of the SDGC and the German Cochrane Centre is fostered and the unit actively participates in training courses for review authors. Results: Since 2005, 14 scientific papers have been published (7 systematic reviews, 2 protocols, 2 overviews of reviews and 3 methodological papers) and 13 projects for systematic reviews are currently underway. Four completed systematic reviews were funded by the BMBF, one by an industrial partner. Two systematic reviews paved the way for the successful design and conduct of large pragmatic trials of the SDGC: Dispact-Trial (ISRCTN 18452029) and ChroPac-Trial. Both trials were funded by the BMBF and DFG. Conclusions: A specialized unit for systematic reviews and meta-analyses was the cornerstone for a successful design and grant application of SDGC trials. In addition, clear treatment recommendations were only possible after pooling of SDGC trial results with other trials in the same area.