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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 3/2019

01-03-2019 | Review Article

Laparoscopic Repair for Perforated Peptic Ulcer Disease Has Better Outcomes Than Open Repair

Authors: Gaik S. Quah, Guy D. Eslick, Michael R. Cox

Published in: Journal of Gastrointestinal Surgery | Issue 3/2019

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Abstract

Purpose

Over the last 3 decades, laparoscopic procedures have emerged as the standard treatment for many elective and emergency surgical conditions. Despite the increased use of laparoscopic surgery, the role of laparoscopic repair for perforated peptic ulcer remains controversial among general surgeons. The aim of this study was to compare the outcomes of laparoscopic versus open repair for perforated peptic ulcer.

Methods

A systemic literature review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted using MEDLINE, EMBASE, PubMed and Cochrane Database of all randomised controlled trials (RCT) that compared laparoscopic (LR) with open repair (OR) for perforated peptic ulcer (PPU). Data was extracted using a standardised form and subsequently analysed.

Results

The meta-analysis using data from 7 RCT showed that LR for PPU has decreased overall post-operative morbidity (LR = 8.9% vs. OR = 17.0%) (OR = 0.54, 95% CI 0.37 to 0.79, p < 0.01), wound infections, (LR = 2.2% vs. OR = 6.3%) (OR = 0.3, 95% CI 0.16 to 0.5, p < 0.01) and shorter duration of hospital stay (6.6 days vs. 8.2 days, p = 0.01). There were no significant differences in length of operation, leakage rate, incidence of intra-abdominal abscess, post-operative sepsis, respiratory complications, re-operation rate or mortality. There was no publication bias and the quality of the studies ranged from poor to good.

Conclusion

These results demonstrate that laparoscopic repair for perforated peptic ulcer has a reduced morbidity and total hospital stay compared with open approach. There are no significant differences in mortality, post-operative sepsis, abscess and re-operation rates. LR should be the preferred treatment option for patients with perforated peptic ulcer disease.
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Metadata
Title
Laparoscopic Repair for Perforated Peptic Ulcer Disease Has Better Outcomes Than Open Repair
Authors
Gaik S. Quah
Guy D. Eslick
Michael R. Cox
Publication date
01-03-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 3/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-4047-8

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