Comparison of Mortality and Postoperative Complications Between Open and Laparoscopic Repair of Perforated Peptic Ulcer: An Umbrella Review.

Background: Perforated peptic ulcer (PPU) is one of the common complications of peptic ulcers. Open repair (OR) is the traditional surgical treatment for this condition, but with advances in laparoscopic and minimally invasive surgery, laparoscopic repair (LR) has gained popularity. Many studies have compared the effectiveness of OR vs. LR for PPU. However, the superiority of one method over the other remains a topic of debate. We conducted this review to investigate the advantages and disadvantages of LR over OR. Methods: PubMed, Scopus, Google Scholar, and Web of Science were searched from 2000 to 2022 for systematic reviews and meta-analyses comparing OR and LR for PPU. Previous studies included seven postoperative outcomes, including mortality, reoperation, postoperative ileus, intra-abdominal abscess, leakage, pneumonia, and wound infection. Two researchers independently extracted data and assessed the quality of the eligible studies using the AMSTAR 2 tool. Results: Five systematic reviews and meta-analyses were included, involving 36 studies. The pooled estimate showed that the risks for mortality, postoperative ileus, and wound infection were significantly lower with LR. In comparison, the risks for reoperation and leakage were less with OR. Based on the pooled estimate, no significant relationship was noted between the surgical method and intraabdominal abscess or postoperative pneumonia. Conclusion: Evidence suggests that in stable patients with PPU, LR is better than OR in terms of mortality. However, more high-quality evidence is needed to determine which is more appropriate for different circumstances (e.g., unstable or high-risk patients).