Laparoscopic repair for perforated peptic ulcer disease (Review)

ABSTRACT: BackgroundPerforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changedthe way to treat such abdominal surgical emergencies. The results of some clinicaltrials suggestthatlaparoscopic surgery could be a betterstrategy than open surgery in the correction of perforated peptic ulcer butthe evidence is not strongly in favour or againstthis intervention.ObjectivesTo measure the eHect of laparoscopic surgical treatment versus open surgical treatment in patients with a diagnosis of perforated pepticulcer in relation to abdominal septic complications, surgical wound infection, extra-abdominal complications, hospital length of stay anddirect costs.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 2, 2004), PubMed/MEDLINE (1966to July 2004), EMBASE (1985 toNovember 2004) and LILACS (1988 toNovember 2004) as well as reference lists ofrelevant articles. Searchesin all databases were updated in December 2009. We did not confine our search to English language publications.Selection criteriaRandomized clinical trials comparing laparoscopic surgery versus open surgery for the repair of perforated peptic ulcer using anymechanical method of closure (suture, omental patch or fibrin sealant).Data collection and analysisPrimary outcome measures included proportion of septic and other abdominal complications (surgical site infection, suture leakage, intraabdominal abscess, postoperative ileus) and extra-abdominal complications (pulmonary). Secondary outcomes included mortality, timeto return to normal diet, time of nasogastric aspiration, hospital length-of-stay and costs. Outcomes were summarized by reporting oddsratios and 95% confidence intervals, using the fixed-eHect model.Main resultsWe included three randomised clinical trials of acceptable quality. We found no statistically significant diHerences between laparoscopicand open surgery in the proportion of abdominal septic complications (OR 0.66, 95% CI 0.30 to 1.47), pulmonary complications (OR 0.52;95% CI 0.08 to 3.55) or number of septic abdominal complications (0.60, 95% CI 0.32 to 1.15). Heterogeneity was significant for pulmonarycomplications and operating time  

• Autores: Sanabria Quiroga, Álvaro Enrique; Villegas Lanau, María Isabel; Morales Uribe, Carlos Hernando
• Tipo de recurso: Review article
• Fecha de publicación: 2005
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: eng
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/26345
• Acceso en línea: http://hdl.handle.net/10495/26345
• Palabra clave: Humanos; Humans; Laparoscopía; Laparoscopy; Úlcera Péptica Perforada - cirugía; Peptic Ulcer Perforation - surgery
• Rights: openAccess
• License: http://creativecommons.org/licenses/by-nc-sa/2.5/co/