Laparoscopic repair of perforated peptic ulcer: a meta-analysis.
BACKGROUND
Laparoscopic repair of perforated peptic ulcer has been gaining popularity in recent years, but few data exist to support the superiority of the laparoscopic approach over open repair. The objective of the current study was to compare the safety and efficacy of open and laparoscopic repair of perforated peptic ulcer in an evidence-based approach using meta-analytical techniques.


METHODS
A search of electronic databases, including MEDLINE and EMBASE, was conducted to identify relevant articles published between January 1990 and December 2002. Only studies in the English language comparing the outcomes of laparoscopic and open repair of perforated peptic ulcer were recruited. All reports were critically appraised with respect to their methodology and outcome. Data from all included studies were extracted using standardized data extraction forms developed a priori. Both qualitative and quantitative statistical analyses were performed. The effect size of outcome parameters was estimated by odds ratio where feasible and appropriate.


RESULTS
A total of 13 publications comprising 658 patients met the inclusion criteria. The overall success rate of laparoscopic repair was 84.7% (n = 249). Postoperative pain was lower after laparoscopic repair than after open repair, supported by a significant reduction in postoperative analgesic requirement after laparoscopic repair. Meta-analyses demonstrated a significant reduction in the wound infection rate after laparoscopic repair, as compared with open repair, but a significantly higher reoperation rate was observed after laparoscopic repair.


CONCLUSIONS
Evidence suggests that laparoscopic repair of perforated peptic ulcer confers superior short-term benefits in terms of postoperative pain and wound morbidity. This approach is as safe and effective as open repair. Laparoscopic Graham-Steele patch repair of perforated duodenal or justapyloric ulcer is beneficial for patients without Boey's risk factors.
Lau
H
H
Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong, China. lauh@hkucc.hku.hk
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome