Laparoscopic repair of perforated peptic ulcer: a meta-analysis

Abstract

Evidence suggests that laparoscopic repair of perforated peptic ulcer confers superior short-term benefits in terms of postoperative pain and wound morbidity. This approach is as safe and effective as open repair. Laparoscopic Graham-Steele patch repair of perforated duodenal or justapyloric ulcer is beneficial for patients without Boey's risk factors.

Laparoscopic Finney pyloroplasty in the emergency setting: first case report in the literature and technical challenges

“…Various laparoscopic approaches and many modified techniques have been evaluated to address gastric and DU. Gastric and duodenal perforations (up to 2 cm in diameter) can be successfully treated with the use of a single-layer suture "Graham patch technique", employing gelatin sponge or fibrin glue (9)(10)(11)(12). Despite the variety of available methods, repair of severe duodenal wall defects which are associated with significant morbidity and mortality remains a challenge (13,14).…”

Outcome of laparoscopic repair of perforated duodenal ulcers

“…(11) However, a Cochrane review of two randomised clinical trials showed no statistically significant differences in the incidence of abdominal septic complications between laparoscopic and open surgery. (12) Although Helicobacter pylori (H. pylori) is a major cause of peptic ulcers, acid reduction procedures are not required for this group of patients, as recurrence of post-eradication ulcer is uncommon.…”

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

“…In Lau's meta-analysis [194], the reoperation rate was higher after the laparoscopic approach (3.7 %) than after conventional surgery (1.6 %) (LE 1a). Suture site leakage represents the most important cause of reoperation (LE 1a).…”

“…A DL is possible when preoperative exams are not sufficiently clear for definitive diagnosis (LE 1a) [122,192,193]. However, failing to identify a PPU represents one of the most frequent causes of conversion to laparotomy (LE 1a) [194].…”