An Updated Meta-Analysis of Laparoscopic Versus Open Repair for Perforated Peptic Ulcer

Abstract

Laparoscopic repair (LR) for perforated peptic ulcer (PPU) has been introduced since 1990. Although many studies comparing LR with open repair (OR) have been published, controversy remains regarding the clinical utility of laparoscopic techniques for the treatment of PPU. Thus, it is necessary for us to broaden our knowledge on this subject with the newly published articles. Twenty-four nonrandomized controlled studies (NRS) and five randomized controlled trails (RCTs) were included in our meta-analyses, which comprised 5,268 patients (1,890 in the LR group and 3,378 in the OR group). In the analysis of high quality NRS and RCTs, compared with OR, high quality evidence suggested that LR was associated with a lower incidence of overall postoperative complications; moderate evidence showed that the two procedures had the similar reoperation rate; based on the low quality evidence, LR had reduced hospital mortality and similar operative time; Moreover, LR was observed having the advantages of earlier resumption of oral intake, shorter hospital stay and less analgesic use, which were supported by very low evidence. All the evidences suggest that LR is better than OR for PPU, but more high-quality RCTs are still needed for further validation.

Surgical treatment of perforated gastroduodenal peptic ulcers: comparison between open and laparoscopic approach

“…5 Many authors have concluded that both open and laparoscopic repair of PPU are equally effective treatments and several authors have also suggested that laparoscopic surgery is not superior to laparotomy due to a lack of direct tactile sense, longer operative times and difficulty in peritoneal cavity flushing. 6 But recent studies corroborated the benefits of the laparoscopic approach. [6][7][8] The advantages of laparoscopic repair (LS) for PPU are; reduced blood loss, less morbidity and mortality, lower wound infections, shorter hospital stay, less postoperative pain and earlier return to daily activities.…”

“…6 But recent studies corroborated the benefits of the laparoscopic approach. [6][7][8] The advantages of laparoscopic repair (LS) for PPU are; reduced blood loss, less morbidity and mortality, lower wound infections, shorter hospital stay, less postoperative pain and earlier return to daily activities. [6][7][8] Laparoscopy allows the confirmation of the diagnosis, better magnified visualization during the procedure and the identification of the position, site and size of the ulcer.…”

“…[6][7][8] Laparoscopy allows the confirmation of the diagnosis, better magnified visualization during the procedure and the identification of the position, site and size of the ulcer. 2,6 It also allows closure of the perforation and adequate peritoneal lavage without the morbidity of a large abdominal incision. 2 We support these opinions, although laparoscopic expertise is required, defining the characteristics of the ulcer is easier due to better visualization and this helps during the suturing of the perforation.…”

“…[6][7][8] The advantages of laparoscopic repair (LS) for PPU are; reduced blood loss, less morbidity and mortality, lower wound infections, shorter hospital stay, less postoperative pain and earlier return to daily activities. [6][7][8] Laparoscopy allows the confirmation of the diagnosis, better magnified visualization during the procedure and the identification of the position, site and size of the ulcer. 2,6 It also allows closure of the perforation and adequate peritoneal lavage without the morbidity of a large abdominal incision.…”

“…1 After the first description of the procedure by Mouret et al and Nathanson et al in the nineties, a number of studies have demonstrated that laparoscopic repair is feasible and safe and even better than the open approach. [4][5][6][7][8] The aim of this study is to compare the surgical outcomes of patients with perforated gastric or duodenal peptic ulcers treated either open or laparoscopic in our institution.…”