General Surgery Department, Associate Professor of General surgery Kasralainy School of Medicine, Cairo University, Giza, Egypt.
Myrthyer Tydfil, Cardiff, UK.
Surg Laparosc Endosc Percutan Tech. 2022 Oct 1;32(5):586-594. doi: 10.1097/SLE.0000000000001086.
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.
To assess the comparative efficacy and safety of laparoscopic and open repair of PPU.
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).
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).
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.
尽管质子泵抑制剂的广泛应用已经降低了消化性溃疡病的发病率，但穿孔性消化性溃疡（PPU）仍然是导致严重并发症和死亡的重要原因。PPU 的开放式或手术修复应基于可靠的指南，这些指南是基于当前的系统证据制定的。
评估腹腔镜与开放式 PPU 修复的疗效和安全性。
基于回顾性、前瞻性队列研究和随机临床试验进行了系统评价和荟萃分析。从合格研究中收集手术持续时间和术后并发症及死亡率，并使用数值和二项结局的均数差值（MD）或相对风险（RR）分别对结局进行汇总。估计的方差表示为 95%置信区间（95%CI）。
纳入了 45 项研究（8456 例患者，56.08%接受了开放式修复，6 项前瞻性研究，7 项随机临床试验，32 项回顾性研究）。与开放式修复相比，腹腔镜手术的手术时间更长（MD=8.36，95%CI，0.49-16.22），住院时间更短（MD=-2.74，95%CI，-3.70 至-1.79），缝合口漏的风险更高（RR=1.91，95%CI，1.04-3.49），死亡率（RR=0.57，95%CI，0.47-0.70）、感染性休克（RR=0.69，95%CI，0.49-0.98）、肾衰竭（RR=0.38，95%CI，0.18-0.79）和伤口感染（RR=0.26，95%CI，0.19-0.37）的风险更低。
腹腔镜修复 PPU 的安全性结果令人鼓舞；然而，未来需要进行精心设计的随机研究，以减少个别研究中观察到的表现偏倚和可能的选择偏倚。
