title: Laparoscopic versus open repair for perforated peptic ulcer: A meta analysis of randomized controlled trials.
abstract: BACKGROUND
  The role of laparoscopic surgery in the repair for peptic ulcer disease is unclear. The present study aimed to compare the safety and efficacy of laparoscopic versus open repair for peptic ulcer disease.
  
  
  METHODS
  Randomized controlled trials (RCTs) comparing laparoscopic versus open repair for peptic ulcer disease were identified from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and references of identified articles and relevant reviews. Primary outcomes were postoperative complications, mortality, and reoperation. Secondary outcomes were operative time, postoperative pain, postoperative hospital stay, nasogastric tube duration, and time to resume diet. Statistical analysis was carried out by Review Manage software.
  
  
  RESULTS
  Five RCTs investigating a total of 549 patients, of whom, 279 received laparoscopic repair and 270 received open repair, were included in the final analysis. There were no significant differences between these two procedures in some primary outcomes including overal postoperative complication rate, mortality, and reoperation rate. Subcategory analysis of postoperative complications showed that laparoscopic repair had also similar rates of repair site leakage, intra-abdominal abscess, postoperative ileus, pneumonia, and urinary tract infection as open surgery, except of the lower surgical site infection rate (P < 0.05). In addition, there were also no significant differences between these two procedures in some second outcomes including operative time, postoperative hospital stay, and time to resume diet, but laparoscopic repair had shorter nasogastric tube duration (P < 0.05) and less postoperative pain (P < 0.05) than open surgery.
  
  
  CONCLUSIONS
  Laparoscopic surgery is comparable with open surgery in the setting of repair for perforated peptic ulcer. The obvious advantages of laparoscopic surgery are the lower surgical site infection rate, shorter nasogastric tube duration and less postoperative pain. However, more higher quality studies should be undertaken to further assess the safety and efficacy of laparoscopic repair for peptic ulcer disease.
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China.
authors: Shanjun
authors: S
authors: Tan
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China. Electronic address: wuguohaozs@163.com.
authors: Guohao
authors: G
authors: Wu
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China.
authors: Qiulin
authors: Q
authors: Zhuang
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China.
authors: Qiulei
authors: Q
authors: Xi
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China.
authors: Qingyang
authors: Q
authors: Meng
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China.
authors: Yi
authors: Y
authors: Jiang
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China.
authors: Yusong
authors: Y
authors: Han
authors: Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, PR China.
authors: Chao
authors: C
authors: Yu
authors: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, PR China.
authors: Zhen
authors: Z
authors: Yu
authors: Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province 210002, PR China.
authors: Ning
authors: N
authors: Li
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D061646:Operative Time; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D016896:Treatment Outcome
keywords: Laparoscopic repair; Meta-analysis; Peptic ulcer