Surgical Management of Perforated Peptic Ulcer: A Comparative Meta-analysis of Laparoscopic Versus Open Surgery.

Autor:	Salman MA; General Surgery Department, Associate Professor of General surgery Kasralainy School of Medicine, Cairo University, Giza, Egypt., Issa M; Myrthyer Tydfil, Cardiff, UK., Salman A; Associate Professor of Internal Medicine , Kasralainy School of Medicine, Cairo University; Cairo University, Giza, Egypt., Tourky M; Great Western Hospital, NHS Foundation Trust, UK., Elewa A; Consultant of General, Laparoscopic and HBP Surgery at National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt., Alrahawy M; Menoufia Faculty of Medicine, Shibin El Kom, Egypt., Shetty N; Speciality Doctor of General Surgery United Lincolnshire NHS Trust, Lincoln, UK., Elsherbiney M; General Surgery Resident Saudi German Hospital, Jeddah, Saudi Arbia., Elhaj MGF; General Surgery Resident Saudi German Hospital, Jeddah, Saudi Arbia., Shaaban HE; National Hepatology and Tropical Medicine Research Institute, Gastroenterology and hepatology, Cairo, Egypt.
Jazyk:	angličtina
Zdroj:	Surgical laparoscopy, endoscopy & percutaneous techniques [Surg Laparosc Endosc Percutan Tech] 2022 Oct 01; Vol. 32 (5), pp. 586-594. Date of Electronic Publication: 2022 Oct 01.
DOI:	10.1097/SLE.0000000000001086
Abstrakt:	Background: Despite the widescale success of proton pump inhibitors to reducing the incidence of peptic ulcer disease, perforated peptic ulcer (PPU) remains a significant cause of severe complications and death. The implementation of open or surgical repair of PPU should be guided by reliable guidelines which are based on current systematic evidence. Objectives: To assess the comparative efficacy and safety of laparoscopic and open repair of PPU. Methods: A systematic review and meta-analysis was conducted based on retrospective, prospective cohort studies, and randomized clinical trials. Duration of surgery and postoperative complications and death were collected from eligible studies, and the outcomes were pooled using mean differences (MD) or relative risks (RRs) for numerical and binary outcomes, respectively. The estimated variance was expressed as 95% confidence intervals (95% CIs). Results: Forty-five studies were included (8456 patients, 56.08% underwent open repair, 6 prospective studies, 7 randomized clinical trials, and 32 retrospective studies). Compared with open repair, laparoscopic surgeries were associated with longer operative times (MD=8.36, 95% CI, 0.49-16.22), shorter hospital stay (MD=-2.74, 95% CI, -3.70 to-1.79), a higher risk of suture leakage (RR=1.91, 95% CI, 1.04-3.49) and lower risks of mortality (RR=0.57, 95% CI, 0.47-0.70), septic shock (RR=0.69, 95% CI, 0.49-0.98), renal failure (RR=0.38, 95% CI, 0.18-0.79), and wound infection (RR=0.26, 95% CI, 0.19-0.37). Conclusion: Laparoscopic repair of PPU showed promising safety outcomes; however, future well-designed randomized studies are warranted to reduce the observed performance bias and possible selection bias in individual studies. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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