The advantages of laparoscopic over open repair for perforated peptic ulcer are not as obvious as they may seem.
Dr Lunevicius and Dr Morkevicius summarized the published trials comparing the 2 approaches.
The research team included 2 randomized prospective, 5 non-randomized prospective and 8 retrospective studies in the analysis.
Relevant trials were identified from the Medline/Pubmed database and the reference lists of the retrieved papers were then analyzed.
| Laparoscopic repair had shorter hospital stay, less wound infection and lower mortality rate|
|British Journal of Surgery|
The outcome measures used by the team were operating time, postoperative analgesic requirements, length of hospital stay, and return to normal diet.
The researchers also assessed usual activities, and complication and mortality rates.
Published data were tested for heterogeneity by means of a 2 test and meta-analysis methods were used to measure the pooled estimate of the effect size.
The researchers reported that 1113 patients are represented from 15 selected studies, of whom 535 were treated by laparoscopic repair and 578 by open repair.
The research team noted that 102 patients underwent conversion to open repair.
Significant findings in favour of laparoscopic repair were less analgesic use, shorter hospital stay, less wound infection and lower mortality rate.
The researchers observed that shorter operating time and less suture-site leakage were advantages of open repair.
In addition, the team noted that hospital stay, operating time and analgesic use were significantly heterogeneous in the papers analyzed.
Dr Lunevicius and colleague commented, “Laparoscopic repair seems better than open repair for low-risk patients.”
“However, limited knowledge about its benefits and risks compared with open repair suggests that the latter, more familiar, approach may be more appropriate in high-risk patients.”
“Further studies are needed.”