Abstrait
Systematic review of curative effect between laparoscopic and open repair for perforated gastroduodenal ulcer
Hu Zhang, Jie Chen, Ying-Jun Li
Background and Objectives: The effectiveness and safety of laparoscopic operation for perforated gastroduodenal ulcer remains controversial. To provide the evidence of rational operations for both doctors and patients by systematically reviewing the curative effect of laparoscopic and open repair for perforated gastroduodenal ulcer.
Methods: The Randomized Controlled Trials (RCTs) about the curative effect of laparoscopic surgery and open repair for perforated gastroduodenal ulcer were electronically searched from the Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), International Statistical Institute (ISI). The standard of literature enrolment and exclusion was made, according to which the literatures were selected. Jadad scale was used to evaluate the chosen study. Data were extracted from these trials and data meta-analysis was performed by RevMan 5.2 software.
Results: Thirteen RCTs involving one thousand and eighteen patients were included (505 patients in the laparoscopic repair group and 513 patients in the open repair group). Meta-analysis showed that compared with conventional open repair group, laparoscopic repair group could reduce the intraoperative blood (P<0.00001)the postoperative time of recovery of intestinal peristalsis (P<0.00001), the off-bed time (P<0.00001), the use of analgesia after operation (P=0.0002), the chance of wound infection after operation (P<0.00001), the ileus after operation (P=0.02), the postoperation hospital stay (P<0.00001). But there was no statistically significant difference in the other curative effect between the two groups, including the operation time (P=0.49), pneumonia after operation (P=0.68), the abdominal abscess after operation (P=0.07), death after operation (P=0.20), the total expense of hospital (P=0.21).
Conclusion: The overall curative effect of laparoscopic repair group in the treatment of perforated gastroduodenal ulcer is better than that of conventional open repair group. Laparoscopic repair for perforated gastroduodenal ulcer is an acceptable alternative.