Safety and Efficacy of the Falciformopexy Technique for Peptic Ulcer Perforation: A Systematic Review and Meta-Analysis.

Abstract

Objectives: Peptic ulcer perforation (PUP) is a severe complication of peptic ulcer disease, associated with significant morbidity and mortality. The Graham patch repair (GPR) is the standard surgical treatment; however, when the greater omentum is insufficient, falciformopexy has emerged as a viable alternative. This study aims to assess the efficacy and safety of falciformopexy for PUP through a systematic review and meta-analysis.

Methods: A systematic search was conducted in PubMed, Scopus, Cochrane, Web of Science, and Ovid to identify studies reporting on PUP patients treated with falciformopexy. Outcomes evaluated included length of hospital stay, perioperative mortality, wound infections, and reoperation rates. A comparative analysis with patients treated with GPR was also performed. Safety and efficacy outcomes were analyzed using single proportions, while risk ratios (RR) with 95% confidence intervals were pooled for comparative assessments.

Results: Six studies involving 868 patients were included, of whom 148 underwent falciformopexy for PUP. The mean hospital stay was 8.76 days (95% CI: 6.5-11.02; I² = 92%). The perioperative mortality rate was 4.38% (95% CI: 0%-10.26%; I² = 53%), the wound infection rate was 6.66% (95% CI: 2.31%-11.02%; I² = 0%), and reoperation was required in 1.76% of cases (95% CI: 0%-4.73%; I² = 0%). Comparative analysis revealed no significant differences between the falciformopexy and GPR groups regarding mortality, wound infections, or reoperation rates.

Conclusion: These results indicate that the use of the falciform ligament for PUP repair is associated with low perioperative mortality, wound infection, and reoperation rates, suggesting it is a viable alternative when the omentum is unavailable.