Skip to main content
SpringerLink
Log in

Laparoscopic repair of perforated peptic ulcer: a meta-analysis

  • Review article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

Laparoscopic repair of perforated peptic ulcer has been gaining popularity in recent years, but few data exist to support the superiority of the laparoscopic approach over open repair. The objective of the current study was to compare the safety and efficacy of open and laparoscopic repair of perforated peptic ulcer in an evidence-based approach using meta-analytical techniques.

Methods

A search of electronic databases, including MEDLINE and EMBASE, was conducted to identify relevant articles published between January 1990 and December 2002. Only studies in the English language comparing the outcomes of laparoscopic and open repair of perforated peptic ulcer were recruited. All reports were critically appraised with respect to their methodology and outcome. Data from all included studies were extracted using standardized data extraction forms developed a priori. Both qualitative and quantitative statistical analyses were performed. The effect size of outcome parameters was estimated by odds ratio where feasible and appropriate.

Results

A total of 13 publications comprising 658 patients met the inclusion criteria. The overall success rate of laparoscopic repair was 84.7% (n = 249). Postoperative pain was lower after laparoscopic repair than after open repair, supported by a significant reduction in postoperative analgesic requirement after laparoscopic repair. Meta-analyses demonstrated a significant reduction in the wound infection rate after laparoscopic repair, as compared with open repair, but a significantly higher reoperation rate was observed after laparoscopic repair.

Conclusions

Evidence suggests that laparoscopic repair of perforated peptic ulcer confers superior short-term benefits in terms of postoperative pain and wound morbidity. This approach is as safe and effective as open repair. Laparoscopic Graham–Steele patch repair of perforated duodenal or justapyloric ulcer is beneficial for patients without Boey’s risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7

Similar content being viewed by others

References

  1. JP Arnaud JJ Tuech R Bergamaschi P Pessaux N Regenet (2002) ArticleTitleLaparoscopic suture closure of perforated duodenal peptic ulcer. Surg Laparosc Endosc Percutan Tech 12 145–147 Occurrence Handle10.1097/00129689-200206000-00001

    Article  Google Scholar 

  2. J Benoit GG Champault E Lebhar A Sezeur (1993) ArticleTitleSutureless laparoscopic treatment of perforated duodenal ulcer [letter]. Br J Surg 80 1212 Occurrence Handle1:STN:280:ByuD3crms1A%3D

    CAS  Google Scholar 

  3. R Bergamaschi R Marvik G Johnsen JE Thoresen B Ystgaard HE Myrvold (1999) ArticleTitleOpen versus laparoscopic repair of perforated peptic ulcers. Surg Endosc 13 679–682 Occurrence Handle10.1007/s004649901072 Occurrence Handle1:STN:280:DyaK1Mzhs1eqtA%3D%3D Occurrence Handle10384074

    Article  CAS  PubMed  Google Scholar 

  4. C Bloechle A Emmermann T Strate UJ Scheurlen C Schneider E Achilles M Wolf D Mack C Zornig CE Broelsch (1998) ArticleTitleLaparoscopic vs open repair of gastric perforation and abdominal lavagae of associated peritonitis in pigs. Surg Endosc 12 212–218 Occurrence Handle10.1007/s004649900637 Occurrence Handle1:STN:280:DyaK1c7mvFGlug%3D%3D Occurrence Handle9502698

    Article  CAS  PubMed  Google Scholar 

  5. C Bloechle A Emmermann H Treu E Achilles D Mack C Zornig CE Broelsch (1995) ArticleTitleEffect of a pneumoperitoneum on the extent and severity of peritonitis induced by gastric ulcer perforation in the rat. Surg Endosc 9 898–901 Occurrence Handle1:STN:280:BymD3MnmvVY%3D Occurrence Handle8525443

    CAS  PubMed  Google Scholar 

  6. C Bloechle A Emmermann C Zornig (1997) ArticleTitleLaparoscopic and conventional closure of perforated peptic ulcer [letter]. Surg Endosc 11 1226–1227 Occurrence Handle10.1007/s004649900577 Occurrence Handle1:STN:280:DyaK1c%2FktlKrsg%3D%3D Occurrence Handle9373302

    Article  CAS  PubMed  Google Scholar 

  7. LG Blomgren (1997) ArticleTitlePerforated peptic ulcer: long-term results after simple closure in the elderly. World J Surg 21 412–415 Occurrence Handle1:STN:280:ByiB1cfmt1c%3D Occurrence Handle9143574

    CAS  PubMed  Google Scholar 

  8. J Boey SK Choi A Poon TT Alagaratnam (1987) ArticleTitleRisk stratification in perforated duodenal ulcer: a prospective validation of predictive factors. Ann Surg 205 22–26 Occurrence Handle1:STN:280:BiiD1Mfpt1w%3D Occurrence Handle3800459

    CAS  PubMed  Google Scholar 

  9. J Boey J Wong (1987) ArticleTitlePerforated aduodenal ulcers. World J Surg 11 319–324 Occurrence Handle1:STN:280:BiiB28rnvVI%3D Occurrence Handle3604239

    CAS  PubMed  Google Scholar 

  10. J Boey J Wong GB Ong (1982) ArticleTitleA prospective study of operative factors in perforated duodenal ulcer. Ann Surg 195 265–269 Occurrence Handle1:STN:280:Bi2C3svgvVc%3D Occurrence Handle7059238

    CAS  PubMed  Google Scholar 

  11. KM Chu KF Kwok SY Law HH Tuen PH Tung FJ Branicki J Wong (1999) ArticleTitleHelicobacter pylori status and endoscopic follow-up of patients having a history of perforated duodenal ulcer. Gastrointest Endosc 50 58–62 Occurrence Handle1:STN:280:DyaK1MzhsFGqtw%3D%3D Occurrence Handle10385723

    CAS  PubMed  Google Scholar 

  12. G Costalat Y Alquier (1995) ArticleTitleCombined laparoscopic and endoscopic treatment of perforated gastroduodenal ulcer using the ligamentum teres hepatis (LTH). Surg Endosc 9 677–680 Occurrence Handle1:STN:280:BymD2srot1c%3D Occurrence Handle7482162

    CAS  PubMed  Google Scholar 

  13. ML Druart R Hee ParticleVan J Etienne GB Cadiere JF Gigot M Legrand JM Limbosch B Navez M Tugilimana E Vyve ParticleVan L Vereecken E Wibin JP Yvergneaux (1997) ArticleTitleLaparoscopic repair of perforated duodenal ulcer: a prospective multicenter clinical trial. Surg Endosc 11 1017–1020 Occurrence Handle10.1007/s004649900515 Occurrence Handle1:STN:280:DyaK1c%2FitFKjug%3D%3D Occurrence Handle9381340

    Article  CAS  PubMed  Google Scholar 

  14. MR Evasovich TC Clark MC Horattas S Holda L Treen (1996) ArticleTitleDoes pneumoperitoneum during laparoscopy increase bacterial translocation? Surg Endosc 10 1176–1179 Occurrence Handle10.1007/s004649900273 Occurrence Handle1:STN:280:ByiC2srotlY%3D Occurrence Handle8939837

    Article  CAS  PubMed  Google Scholar 

  15. RR Graham (1938) ArticleTitleThe surgeon’s problem in duodenal ulcer. Am J Surg 40 102–117 Occurrence Handle10.1016/S0002-9610(38)90594-X

    Article  Google Scholar 

  16. GG Jamieson (2000) ArticleTitleCurrent status of indications for surgery in peptic ulcer disease. World J Surg 24 256–258 Occurrence Handle10.1007/s002689910041 Occurrence Handle1:STN:280:DC%2BD3c7is1Ciuw%3D%3D Occurrence Handle10658057

    Article  CAS  PubMed  Google Scholar 

  17. B Johansson B Hallerback H Glise E Johnsson (1996) ArticleTitleLaparoscopic suture closure of perforated peptic ulcer: a nonrandomized comparison with open surgery. Surg Endosc 10 656–658 Occurrence Handle10.1007/s004649900122 Occurrence Handle1:STN:280:BymB2s%2FitlQ%3D Occurrence Handle8662407

    Article  CAS  PubMed  Google Scholar 

  18. N Katkhouda E Mavor RJ Mason GM Campos A Soroushyari TV Berne (1999) ArticleTitleLaparoscopic repair of perforated duodenal ulcers: outcome and efficacy in 30 consecutive patients. Arch Surg 134 845–850 Occurrence Handle10.1001/archsurg.134.8.845 Occurrence Handle1:STN:280:DyaK1MzntFCjtQ%3D%3D Occurrence Handle10443807

    Article  CAS  PubMed  Google Scholar 

  19. M Khoursheed M Fuad H Safar H Dashti A Behbehani (2000) ArticleTitleLaparoscopic closure of perforated duodenal ulcer. Surg Endosc 14 56–58 Occurrence Handle10.1007/s004649900011 Occurrence Handle1:STN:280:DC%2BD3c7hs12gug%3D%3D Occurrence Handle10653237

    Article  CAS  PubMed  Google Scholar 

  20. KY Kok VV Mathew SK Yapp (1999) ArticleTitleLaparoscopic omental patch repair for perforated duodenal ulcer. Am Surg 65 27–30 Occurrence Handle1:STN:280:DyaK1M7ht1OgsQ%3D%3D Occurrence Handle9915527

    CAS  PubMed  Google Scholar 

  21. SA Lagoo TN Pappas (2002) ArticleTitleLaparoscopic repair for perforated peptic ulcer. Ann Surg 235 320–321 Occurrence Handle10.1097/00000658-200203000-00002 Occurrence Handle11882752

    Article  PubMed  Google Scholar 

  22. WY Lau (2002) ArticleTitlePerforated peptic ulcer: open versus laparoscopic repair. Asian J Surg 25 267–269 Occurrence Handle1:STN:280:DC%2BD38jgvVKmtw%3D%3D Occurrence Handle12470996

    CAS  PubMed  Google Scholar 

  23. WY Lau CK Leow (1997) ArticleTitleHistory of perforated duodenal and gastric ulcers. World J Surg 21 890–896 Occurrence Handle10.1007/s002689900323 Occurrence Handle1:STN:280:ByiH28flvFM%3D Occurrence Handle9327684

    Article  CAS  PubMed  Google Scholar 

  24. WY Lau KL Leung KH Kwong 1C Davey C Robertson JJ Dawson SC Chung AK Li (1996) ArticleTitleA randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique. Ann Surg 224 131–138 Occurrence Handle10.1097/00000658-199608000-00004 Occurrence Handle1:STN:280:BymA3srgsV0%3D Occurrence Handle8757375

    Article  CAS  PubMed  Google Scholar 

  25. WY Lau KL Leung XL Zhu YH Lam SC Chung AK Li (1995) ArticleTitleLaparoscopic repair of perforated peptic ulcer. Br J Surg 82 814–816 Occurrence Handle1:STN:280:ByqA2MzmsFY%3D Occurrence Handle7627519

    CAS  PubMed  Google Scholar 

  26. FY Lee KL Leung PB Lai JW Lau (2001) ArticleTitleSelection of patients for laparoscopic repair of perforated peptic ulcer. Br J Surg 88 133–136 Occurrence Handle10.1046/j.1365-2168.2001.01642.x Occurrence Handle1:STN:280:DC%2BD3M7isFGhtw%3D%3D Occurrence Handle11136326

    Article  CAS  PubMed  Google Scholar 

  27. FY Lee KL Leung PB Lai SS Ng S Dexter WY Lau (2001) ArticleTitlePredicting mortality and morbidity of patients operated on for perforated peptic ulcer. Arch Surg 136 90–94 Occurrence Handle10.1001/archsurg.136.1.90 Occurrence Handle1:STN:280:DC%2BD3M7hslCltg%3D%3D Occurrence Handle11146785

    Article  CAS  PubMed  Google Scholar 

  28. M Matsuda M Nishiyama T Hanai S Saeki T Watanabe (1995) ArticleTitleLaparoscopic omental patch repair for the perforated peptic ulcer. Ann Surg 221 236–240 Occurrence Handle1:STN:280:ByqB3szot1w%3D Occurrence Handle7717776

    CAS  PubMed  Google Scholar 

  29. VG Mehendale SN Shenoy AM Joshi NC Chaudhari (2002) ArticleTitleLaparoscopic versus open surgical closure of perforated duodenal ulcers: a comparative study. Indian J Gastroenterol 21 222–224 Occurrence Handle12546172

    PubMed  Google Scholar 

  30. I Michelet F Agresta (2000) ArticleTitlePerforated peptic ulcer: laparoscopic approach. Eur J Surg 66 405–408

    Google Scholar 

  31. M Miserez E Eypasch W Spangenberger R Lefering H Troidl (1996) ArticleTitleLaparoscopic and conventional closure of perforated peptic ulcer: a comparison. Surg Endosc 10 831–836 Occurrence Handle10.1007/s004649900171 Occurrence Handle1:STN:280:BymA2M7gtVc%3D Occurrence Handle8694948

    Article  CAS  PubMed  Google Scholar 

  32. P Mouret Y Francois J Vignal X Barth R Lombard-Platet (1990) ArticleTitleLaparoscopic treatment of perforated peptic ulcer. Br J Surg 77 1006 Occurrence Handle1:STN:280:By6D3czisVU%3D Occurrence Handle2145052

    CAS  PubMed  Google Scholar 

  33. JM Naesgaard B Edwin O Reiertsen E Trondsen AE Faerden AR Rosseland (1999) ArticleTitleLaparoscopic and open operation in patients with perforated peptic ulcer. Eur J Surg 165 209–214 Occurrence Handle10.1080/110241599750007063 Occurrence Handle1:STN:280:DyaK1M3kvVCgtw%3D%3D Occurrence Handle10231653

    Article  CAS  PubMed  Google Scholar 

  34. LK Nathanson DW Easter A Cuschieri (1990) ArticleTitleLaparoscopic repair/peritoneal toilet of perforated duodenal ulcer. Surg Endosc 4 232–233 Occurrence Handle1:STN:280:By6C2M%2Fgt1Q%3D Occurrence Handle2149782

    CAS  PubMed  Google Scholar 

  35. EK Ng YH Lam JJ Sung MY Yung KF To AC Chan DW Lee BK Law JY Lau TK Ling WY Lau SC Chung (2000) ArticleTitleEradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg 231 153–158 Occurrence Handle10.1097/00000658-200002000-00001 Occurrence Handle1:STN:280:DC%2BD3c7jslSluw%3D%3D Occurrence Handle10674604

    Article  CAS  PubMed  Google Scholar 

  36. GS Robertson SA Wemyss-Holden GJ Maddern (2000) ArticleTitleLaparoscopic repair of perforated peptic ulcers: the role of laparoscopy in generalised peritonitis. Ann R Coll Surg Engl 82 6–10 Occurrence Handle1:STN:280:DC%2BD3c7msFGrtw%3D%3D Occurrence Handle10700758

    CAS  PubMed  Google Scholar 

  37. M Schein G Gecelter Z Freinkel H Gerding (1990) ArticleTitleAPACHE II in emergency operations for perforated ulcers. Am J Surg 159 309–313 Occurrence Handle1:STN:280:By%2BC28voslU%3D Occurrence Handle2305938

    CAS  PubMed  Google Scholar 

  38. M Sebastian VP Chandran YI Elashaal AJ Sim (1995) ArticleTitleHelicobacter pylori infection in perforated peptic ulcer disease. Br J Surg 82 360–362 Occurrence Handle1:STN:280:ByqA3MnjvVM%3D Occurrence Handle7796009

    CAS  PubMed  Google Scholar 

  39. WT Siu HT Leong BK Law CH Chau AC Li KH Fung YP Tai MK Li (2002) ArticleTitleLaparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg 235 313–319 Occurrence Handle10.1097/00000658-200203000-00001 Occurrence Handle11882751

    Article  PubMed  Google Scholar 

  40. WT Siu HT Leong MK Li (1997) ArticleTitleSingle-stitch laparoscopic omental patch repair of perforated peptic ulcers. J R Coll Surg Edinb 42 92–94 Occurrence Handle1:STN:280:ByiB28bmt1U%3D Occurrence Handle9114677

    CAS  PubMed  Google Scholar 

  41. JB So CK Kum ML Fernandes P Goh (1996) ArticleTitleComparison between laparoscopic and conventional omental patch repair for perforated duodenal ulcer. Surg Endosc 10 1060–1063 Occurrence Handle10.1007/s004649900240 Occurrence Handle1:STN:280:ByiD2crgsFI%3D Occurrence Handle8881052

    Article  CAS  PubMed  Google Scholar 

  42. GT Sunderland EM Chisholm WY Lau SC Chung AK Li (1992) ArticleTitleLaparoscopic repair of perforated peptic ulcer. Br J Surg 79 785 Occurrence Handle1:STN:280:ByyD3cnpslY%3D Occurrence Handle1393473

    CAS  PubMed  Google Scholar 

  43. C Svanes RT Lie K Svanes SA Lie O Soreide (1994) ArticleTitleAdverse effects of delayed treatment for perforated peptic ulcer. Ann Surg 220 168–175 Occurrence Handle1:STN:280:ByuA3s%2FnslI%3D Occurrence Handle8053739

    CAS  PubMed  Google Scholar 

  44. H Takeuchi T Kawano T Toda Y Minamisono S Nagasaki K Sugimachi (1998) ArticleTitleLaparoscopic repair for perforation of duodenal ulcer with omental patch: report of initial six cases. Surg Laparosc Endosc 8 153–156 Occurrence Handle10.1097/00019509-199804000-00016 Occurrence Handle1:STN:280:DyaK1c3is1ahtw%3D%3D Occurrence Handle9566573

    Article  CAS  PubMed  Google Scholar 

  45. JJ Tate JW Dawson WY Lau AK Li (1993) ArticleTitleSutureless laparoscopic treatment of perforated duodenal ulcer. Br J Surg 80 235–238 Occurrence Handle1:STN:280:ByyC1cvosFA%3D Occurrence Handle8443667

    CAS  PubMed  Google Scholar 

  46. AR Thompson TJ Hall BA Anglin CE Scott-Conner (1995) ArticleTitleLaparoscopic plication of perforated ulcer: results of a selective approach. South Med J 88 185–189 Occurrence Handle1:STN:280:ByqC2c7gvFU%3D Occurrence Handle7839161

    CAS  PubMed  Google Scholar 

  47. Y Tokunaga K Hata J Ryo A Kitaoka A Tokuka K Ohsumi (1998) ArticleTitleDensity of Helicobacter pylori infection in patients with peptic ulcer perforation. J Am Coll Surg 186 659–663 Occurrence Handle10.1016/S1072-7515(98)00128-8 Occurrence Handle1:STN:280:DyaK1c3ptl2nsQ%3D%3D Occurrence Handle9632154

    Article  CAS  PubMed  Google Scholar 

  48. K Tsugawa N Koyanagi M Hashizume M Tomikawa K Akahoshi K Ayukawa H Wada K Tanoue K Sugimachi (2001) ArticleTitleThe therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age. Hepatogastroenterology 48 156–162 Occurrence Handle1:STN:280:DC%2BD3M7mvVegtw%3D%3D Occurrence Handle11268955

    CAS  PubMed  Google Scholar 

  49. WW Turner SuffixJr WM Thompson SuffixJr ER Thal (1988) ArticleTitlePerforated gastric ulcers: a plea for management by simple closures. Arch Surg 123 960–964 Occurrence Handle3395239

    PubMed  Google Scholar 

  50. J Wissing TJ Vroonhoven Particlevan ME Schattenkerk HF Veen RJ Ponsen J Jeekel (1987) ArticleTitleFascia closure after midline laparotomy: results of a randomized trial. Br J Surg 74 738–741 Occurrence Handle1:STN:280:BieD3c7ivFA%3D Occurrence Handle3307992

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The author acknowledges the kind assistance of Tze-Ching Tan, MD in editing the manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong, China

    H. Lau

Authors
  1. H. Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Lau.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lau, H. Laparoscopic repair of perforated peptic ulcer: a meta-analysis. Surg Endosc 18, 1013–1021 (2004). https://doi.org/10.1007/s00464-003-8266-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-003-8266-y

Keywords

Search

Navigation