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.
Highlights
The management of perforated peptic ulcer (PPU) has evolved greatly in the past three decades
13 nonrandomized studies (NRS), indicated that laparoscopic repair (LR) had the advantages of less analgesic use, a shorter hospital stay, a lower risk of wound infection and a lower mortality rate but a longer operating time and a greater occurrence of suture-site leakage
To get the more reliable conclusions, we focused on the results of the high quality NRS and randomized controlled trials (RCTs)
Summary
The management of perforated peptic ulcer (PPU) has evolved greatly in the past three decades. Several authors have 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. To resolve these disputes, several meta-analyses on the advantages of LR vs OR have been published. The latest meta-analysis, which was published in 2013, included 4 RCTs with 289 patients and suggested that the two approaches had similar morbidity, mortality, and reoperation rates. The conclusions of these meta-analyses were contradictory. We performed an updated meta-analysis to determine the relative effectiveness of laparoscopic repair for PPU
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