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

Abstract

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.

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

“…A gastroduodenogram is usually needed to evaluate water-soluble contrast extravasation. If there is no contrast extravasation, it is suggestive of a self-sealed microperforation ( 12 , 34 ). Endoscopic repair is another option for UGI perforation owing to its minimal invasiveness.…”

“…In the present case series, simple suturing was performed in most cases in both groups; only two patients underwent laparoscopically pedicled omental patch repair. 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 – 50 ).…”

“…Due to effective acid suppression, peptic gastroduodenal ulcer perforation has become less prevalent ( 11 , 12 ), and endoscopic management of surgical gastrointestinal diseases has rapidly increased with advancements in endoscopic techniques over the last decade. Thus, the risk of iatrogenic perforation related to endoscopic procedures for UGI may increase ( 9 – 11 ).…”

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

“…Com escopo de avaliar a eficácia comparativa e a segurança do reparo laparoscópico em comparação ao aberto para UPP, Salman et al (2022) conduziram uma revisão sistemática com meta-análise, com 45 estudos incluídos, constatando que são menores os riscos de complicações trans e pós-operatórias, como rompimento de sutura, choque séptico, insuficiência renal, infecção da ferida e óbito. Em se tratado de reparo laparoscópico com e sem correção omental, uma revisão sistemática com meta-análise conduzida por Mohamedahmed et al (2022) afirmou que não houve diferença no risco de íleo pós-operatório, vazamento, infecção da ferida, abscesso intra-abdominal e necessidade de reoperação.…”

“…Como exposto anteriormente, a literatura frequentemente associa-se a laparoscoscopia a um menor tempo cirúrgico. Diferentemente, estudos primários (VAKAYIL et al, 2019;AKIN et al, 2022), como também uma revisão sistemática, as cirurgias laparoscópicas foram associadas a tempos operatórios mais longos (SALMAN et al, 2022). Logo, em relação ao tempo cirúrgico, não há um consenso nos estudos apresentados.…”