Meta-analysis of perioperative outcomes of acute laparoscopic vs open repair of perforated gastroduodenal ulcers

BACKGROUND Surgery is the treatment of choice for perforated peptic ulcer disease (PUD). The aim of the present review is to compare the perioperative outcomes of acute laparoscopic versus open repair for PUD. METHODS A systematic literature search was performed for randomized controlled trials (RCTs) published in PubMed, SCOPUS and Web of Science RESULTS The search included eight RCTs: 615 patients comparing laparoscopic (307 patients) versus open peptic perforated ulcer repair (308 patients). Only few studies reported the Boey’ score, APACHE’ score and Mannheim Peritonitis Index..In the RCTs, there is a significant heterogeneity about the gastric or duodenal location of peptic ulcer and perforation size. All trials were with high risk of bias. This meta-analysis reported a significant advantage of laparoscopic repair only for post-operative pain in first 24 hours (MD -2.08, 95% CI -2.79 to -1.37;) and for post-operative wound infection (RR 0.39, 95% CI 0.23 to 0.66). An equivalence of the other clinical outcomes (post-operative mortality rate, overall re-operation rate, overall leaks of the suture repair, intra-abdominal abscess rate, operative time of post-operative hospital stay, naso-gastric aspiration time and time to return to oral diet) was reported. CONCLUSION In this meta-analysis, there were no significant differences in most of the clinical outcomes between the two groups, there was less early postoperative pain and fewer wound infections after laparoscopic repair. The reported equivalence of clinical outcomes is an important finding. These results parallel the results of several other comparisons of open versus laparoscopic general surgery operations - equally efficacious with lower rates of wound infection and improvement in some measures of enhanced speed or comfort in recovery. Notably, the trials included have been published throughout a considerable time-span during which several changes have occurred in most health care systems, not least a widespread use of laparoscopy and increase in the laparoscopic skills. LEVEL OF EVIDENCE Systematic review, level of Evidence I Conflicts of Interest and Source of Funding: NONE © 2018 Lippincott Williams & Wilkins, Inc.

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