Comparison of laparoscopic and open suturing of perforated peptic ulcer complicated by advanced peritonitis

Issa²,

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

et al. 2022

Background: Despite the widescale success of proton pump inhibitors to reducing the incidence of peptic ulcer disease, perforated peptic ulcer (PPU) remains a significant cause of severe complications and death.The implementation of open or surgical repair of PPU should be guided by reliable guidelines which are based on current systematic evidence.Objectives: To assess the comparative efficacy and safety of laparoscopic and open repair of PPU.Methods: A systematic review and meta-analysis was conducted based on retrospective, prospective cohort studies, and randomized clinical trials. Duration of surgery and postoperative complications and death were collected from eligible studies, and the outcomes were pooled using mean differences (MD) or relative risks (RRs) for numerical and binary outcomes, respectively. The estimated variance was expressed as 95% confidence intervals (95% CIs).Results: Forty-five studies were included (8456 patients, 56.08% underwent open repair, 6 prospective studies, 7 randomized clinical trials, and 32 retrospective studies). Compared with open repair, laparoscopic surgeries were associated with longer operative times (MD = 8.36, 95% CI, 0.49-16.22), shorter hospital stay (MD = −2.74, 95% CI, −3.70 to−1.79), a higher risk of suture leakage (RR = 1.91, 95% CI, 1.04-3.49) and lower risks of mortality (RR = 0.57, 95% CI, 0.47-0.70), septic shock (RR = 0.69, 95% CI, 0.49-0.98), renal failure (RR = 0.38, 95% CI, 0.18-0.79), and wound infection (RR = 0.26, 95% CI, 0.19-0.37). Conclusion:Laparoscopic repair of PPU showed promising safety outcomes; however, future well-designed randomized studies are warranted to reduce the observed performance bias and possible selection bias in individual studies.

Section: Results Of the Search Processmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Surgical Management of Perforated Peptic Ulcer: A Comparative Meta-analysis of Laparoscopic Versus Open Surgery

Issa²,

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

et al. 2022

“…Stepanyan et al (2018) 2017), as complicações incluíram infecções superficiais de sítio cirúrgico (2,4%), cardiovasculares (1,6%), pulmonares (1%), vazamentos duodenais (0,7%), infecções de espaços profundos (1%) e hemorragia digestiva alta (0,3%). Nesse ínterim, taxas de complicações extra-abdominais alcançam índices de até 41,2%, em laparotomia (SAZHIN et al, 2020). Mirabella et al (2018) por meio de um estudo multicêntrico retrospectivo constataram que complicações pós-operatórias aconteceram em 9,7% dos pacientes de laparotomia, especificadas pelo escore de Boey, sendo mais comuns os escores de alto risco (21,4%) do que no grupo de escores médio a baixo (4,7%).…”

Section: Complicações Trans E Pós-operatóriasunclassified

Laparoscopia versus laparotomia na Úlcera Péptica Perfurada: revisão de literatura dos últimos cinco anos

Mota¹,

Oliveira²,

Squeff³

et al. 2023

Braz. J. Hea. Rev.

A úlcera péptica é uma enfermidade que afeta milhões de pessoas. Apesar dos avanços quanto ao entendimento e tratamento da doença, o número de pacientes diagnosticados com perfuração de úlcera péptica não vem diminuindo. Concomitantemente, a taxa de mortalidade supera outras situações de emergência comuns. O padrão-referência para perfurações simples é o reparo laparoscópico, porém grandes ulcerações perfuradas, a laparotomia com piloroplastia pode se tornar a melhor escolha. O presente trabalho tem como objetivo fornecer uma síntese das evidências atuais acerca dos aspectos biológicos e clínicos envolvidos nas técnicas laparoscópicas e laparotômicas para correção de úlcera péptica perfurada. A coleta de dados ocorreu por meio de busca bibliográfica na base de dados PubMed (via National Library of Medicine), utilizando os descritores “Peptic ulcer”, “Laparoscopic”, “Laparoscopy”, “Laparotomy”. Foram selecionados 56 trabalhos publicados entre 2017 e 2022. Considerando que há diferentes técnicas cirúrgicas para correção de úlcera peptídica perfurada, a revisão traz a definição correta de tal condição, bem como com a abordagem de cada técnica, envolvendo aspectos inerentes às indicações e contraindicações, complicações trans e pós-operatórias, tempo de internação, tempo de cirurgia, custo financeiro e taxa de mortalidade. Os resultados do presente estudo podem ajudar a desenvolver estratégias eficientes e seguras para a prevenção e o tratamento dessa condição, além de contribuir para uma conduta adequada durante a terapia dos indivíduos.

“…Surgery is the most effective management for PPU. [ 19 , 20 ] However, most patients with PPU also suffer from psychological disorder (including depression and anxiety). [ 21 ] Previous studies have reported that comprehensive nursing intervention (CNI) can be utilized for the management of elderly patients with PPU.…”

Section: Introductionmentioning

confidence: 99%

Psychological effect of comprehensive nursing intervention in elderly patients with perforated peptic ulcer

et al. 2020

Background: This study aims to assess the psychological effect of comprehensive nursing intervention (CNI) in elderly patients with perforated peptic ulcer (PPU). Methods: This protocol will search all potential studies from inception to the present in electronic database sources (Cochrane Library, PUBMED, EMBASE, PsycINFO, WANGFANG, CBM, and CNKI), and other sources (such as clinical trial registry, and conference proceedings). We will not apply limitations to language and publication status. Two independent authors will scan literature, extract data, and appraise study quality. A third author will be invited to solve any disagreements between 2 authors. We will utilize RevMan 5.3 software for statistical analysis. If necessary, we will also carry out subgroup group, sensitivity analysis, and reporting bias. Results: This protocol will summarize high quality evidence to evaluate the psychological effect of CNI in elderly patients with PPU. Conclusion: The results of this study may provide evidence to determine whether CNI is effective or not on psychological effect in elderly patients with PPU. Study registration: INPLASY202080069.