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Meta-analysis of laparoscopic versus open repair of perforated peptic ulcer
Stavros A Antoniou1, George A Antoniou, Oliver O Koch
1Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany. stavros.antoniou@hotmail.com
Background And Objectives:
Laparoscopic treatment of perforated peptic ulcer (PPU) has been introduced as an alternative procedure to open surgery. It has been postulated that the minimally invasive approach involves less operative stress and results in decreased morbidity and mortality.
Methods:
We conducted a meta-analysis of randomized trials to test this hypothesis. Medline, EMBASE, and the Cochrane Central Register of Randomized Trials databases were searched, with no date or language restrictions.
Results:
Our literature search identified 4 randomized trials, with a cumulative number of 289 patients, that compared the laparoscopic approach with open sutured repair of perforated ulcer. Analysis of outcomes did not favor either approach in terms of morbidity, mortality, and reoperation rate, although odds ratios seemed to consistently support the laparoscopic approach. Results did not determine the comparative efficiency and safety of laparoscopic or open approach for PPU.
Conclusion:
In view of an increased interest in the laparoscopic approach, further randomized trials are considered essential to determine the relative effectiveness of laparoscopic and open repair of PPU.
Insights
Laparoscopic surgery for perforated peptic ulcer (PPU) shows no clear advantage over open surgery in reducing complications. Further research is needed to determine the comparative effectiveness and safety of these PPU treatment options.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Evidence-Based Medicine
Background:
- Perforated peptic ulcer (PPU) is a serious condition often treated with open surgery.
- Laparoscopic surgery has been proposed as a less invasive alternative to open repair for PPU.
- The hypothesis suggests laparoscopic PPU repair may reduce operative stress, morbidity, and mortality.
Purpose of the Study:
- To compare the effectiveness and safety of laparoscopic versus open surgical repair for perforated peptic ulcers (PPU).
- To evaluate the impact of surgical approach on patient outcomes, including morbidity, mortality, and reoperation rates.
Main Methods:
- A meta-analysis was conducted on randomized controlled trials (RCTs).
- Databases searched included Medline, EMBASE, and the Cochrane Central Register of Randomized Trials.
- No date or language restrictions were applied to the literature search.
Main Results:
- Four randomized trials with a total of 289 patients were included in the analysis.
- The meta-analysis did not find significant differences between laparoscopic and open repair in terms of morbidity, mortality, or reoperation rates.
- While odds ratios suggested a trend favoring the laparoscopic approach, results were inconclusive regarding comparative efficiency and safety.
Conclusions:
- Current evidence from randomized trials is insufficient to definitively establish the superiority of laparoscopic repair over open repair for PPU.
- Further high-quality randomized trials are essential to clarify the relative effectiveness and safety of both surgical approaches for PPU treatment.
