An Updated Meta-Analysis of Laparoscopic Versus Open Repair for Perforated Peptic Ulcer.
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.
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.|Hangzhou First People's Hospital, Hangzhou, China.
Chunhua
C
Zhou
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Weizhi
W
Wang
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Jiwei
J
Wang
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.|The Second People's Hospital of Huaian, Huaian, China.
Xiaoyu
X
Zhang
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Qun
Q
Zhang
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Bowen
B
Li
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.|Collaborative Innovation Center For Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.
Zekuan
Z
Xu
D013505:Digestive System Surgical Procedures; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D009017:Morbidity; D061646:Operative Time; D010439:Peptic Ulcer Perforation / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D017594:Publication Bias; D016896:Treatment Outcome