A systematic review and meta-analysis comparing postoperative outcomes of laparoscopic versus open omental patch repair of perforated peptic ulcer

Abstract

BACKGROUND:The mainstay of surgical management of perforated peptic ulcer is omental patch repair. Advances in minimally invasive techniques have shown feasibility of laparoscopic omental patch repair (LOPR). Laparoscopic omental patch repair is limited by learning curve (LC), but there is a lack of reporting of LC in LOPR. This study aims to compare outcomes following LOPR versus open omental patch repair (OOPR) with reporting of LC. METHODS: PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till January 2022 for randomized controlled trials (RCTs) and non-RCTs comparing LOPR and OOPR in perforated peptic ulcer. Exclusion criteria were primary repair without use of omental patch repair. Primary outcomes were 30-day mortality, postoperative leak, and LC analysis. RESULTS: There were a total of 29 studies including 5,311 patients (LOPR, n = 1,687; OOPR, n = 3,624), with 4 RCTs with 238 patients (LOPR, n = 118; OOPR, n = 120). Majority of ulcers were located in the duodenum (57.0%) followed by stomach (30.7%). Mean ulcer size ranged from 5 to 16.2 mm in LOPR and 4.7 to 15.8 mm in OOPR. Laparoscopic omental patch repair was associated with lower 30-day mortality (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35-0.92; p = 0.02), overall morbidity (OR, 0.31; 95% CI, 0.18-0.53; p < 0.0001), surgical site infection (OR, 0.27; 95% CI, 0.18-0.42; p < 0.00001), and length of stay (mean difference, −2.84 days; 95% CI, −3.63 to −2.06; p < 0.00001). Postoperative leakage (OR, 1.06; 95% CI, 0.43-2.61; p = 0.90) was comparable between LOPR and OOPR. Only three studies analyzed the proportion of consultants to trainees; LOPR was performed mainly by consultants (range, 82.4-91.4%), while OOPR was mainly performed by trainees (range, 52.8-96.8%). One study showed that consultants who performed open conversion had shorter operating time compared with chief residents (85 vs. 186.6 minutes, p < 0.003). CONCLUSION:Laparoscopic omental patch repair has lower mortality, overall morbidity, length of stay, intraoperative blood loss, and postoperative pain compared with OOPR. More prospective studies should be conducted to evaluate LC in LOPR. (

Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer: A 9-year review

“…Comparing miMVR as a whole vs oMVR, our study demonstrated better short-term outcomes. This is not surprising; benefits of MIS have been shown to be superior compared with open surgery in both benign and malignant conditions, such as omental patch repair for perforated peptic ulcer, oesphagectomy, colorectal resection and liver resection[ 12 - 15 ]. The concept behind the benefits of MIS remains the same regardless of the type of surgery.…”

“…Nevertheless, MVR and/or PE is a major and complex surgery with post-operative morbidity ranging from 20%-80%[ 8 ], and 30-d mortality of 0.5%-2.0%[ 9 - 11 ]. Minimally invasive surgery (MIS) which has been well-established as standard of care both benign and malignant intra-abdominal pathologies[ 12 - 15 ], may prove its utility on short-term post-operative outcomes. A retrospective study by Kazi et al [ 16 ] on 158 patients who underwent PE for LARC showed reduced intra-operative blood loss (900 vs 1600 mL, P < 0.001) and incidence of wound infections (8.2% vs 17.5%, P = 0.02) for minimally invasive PE compared with open PE, with similar 3-year overall survival (OS)[ 16 ].…”

Experience of management of pediatric upper gastrointestinal perforations: a series of 30 cases

“…The simple suture technique to repair the PPU is usually recommended because of its feasibility and low procedure time (12,15,42). Pedicled omental patch repair is another favorable technique, especially in cases with a friable edge or a large perforation, which cannot allow the approximation of perforation edges (20,(48)(49)(50). Regarding postoperative management for those PPU with H. pylori infection, proton pump inhibitors and eradication of H. pylori infection are essential to reduce peptic ulcer recurrence (40,51,52).…”

Fast‐track recovery after surgery for perforated peptic ulcer safely shortens hospital stay: A systematic review and meta‐analysis of six randomized controlled trials and 356 patients

“…2,3 For select cases, purely endoscopic options, such as stent placement, Over The Scope Clips (OTSC®), and Endoscopic Vacuum Therapy, are also emerging. [4][5][6][7] Yet, the postoperative management of this condition is still burdened by old traditions such as prolonged nasogastric decompression and nil per os. 8 Enhanced recovery after surgery or fast-track recovery has been used with good results in elective procedures to optimize outcomes since the 1990s.…”