IS LAPAROSCOPIC SURGERY BECOMING THE FIRST CHOICE IN TREATMENT OF PERFORATED PEPTIC ULCER?
Perforated peptic ulcer (PPU), a significant complication of peptic ulcer disease, has proven to be associated with high rates of mortality and morbidity and to this day, it remains a clear indication of emergency surgery. Whilst open repair remains a feasible treatment option for this complication, the development of laparoscopic surgery has brought along new perspectives, by revealing the benefits and drawbacks of this procedure and therefore raising the question whether it should be the first choice in treatment of a PPU. A literature search was performed using PubMed, Web of Science and Scopus, with the selection of relevant articles from the last 15 years. By comparing the two surgical approaches, conventional and laparoscopic, we aimed to identify the reasons laparoscopy is gaining ground as a mean of treatment of a PPU. Outcomes such as hospital stay, complication rates, use of postoperative analgesics and visual analogue scale favored laparoscopy. The most heterogeneous result was dictated by the operation time, which seems to correlate with multiple factors, a major one being the learning curve and skills this procedure requires. In addition, a significant number of papers had developed patient inclusion and exclusion criteria, which impacted the results of outcomes like morbidity and mortality. There is a lot of evidence that points to laparoscopy becoming the preferred method of treatment of a PPU, however further research is needed in order to reach a consensus.
 K. Ramakrishnan and R. C. Salinas, “Peptic ulcer disease,” American Family Physician, vol. 76, no. 7. 01-Oct-2007.
 A. Tarasconi et al., “Perforated and bleeding peptic ulcer: WSES guidelines,” World Journal of Emergency Surgery, vol. 15, no. 1. BioMed Central Ltd., pp. 1–24, 07-Jan-2020.
 K. T. Chung and V. G. Shelat, “Perforated peptic ulcer - an update,” World J. Gastrointest. Surg., vol. 9, no. 1, p. 1, 2017.
 P. Mouret, Y. François, J. Vignal, X. Bartht, and R. Lombard‐Platet, “Laparoscopic treatment of perforated peptic ulcer,” Br. J. Surg., vol. 77, no. 9, pp. 1006–1006, 1990.
 S. Tan et al., “Laparoscopic versus open repair for perforated peptic ulcer: A meta analysis of randomized controlled trials,” International Journal of Surgery, vol. 33. Elsevier Ltd, pp. 124–132, 01-Sep-2016.
 R. Laforgia et al., “Laparoscopic and Open Surgical Treatment in Gastroduodenal Perforations: Our Experience,” Surg. Laparosc. Endosc. Percutaneous Tech., vol. 27, no. 2, pp. 113–115, 2017.
 M. J. O. E. Bertleff et al., “Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: The LAMA trial,” World J. Surg., vol. 33, no. 7, pp. 1368–1373, Jul. 2009.
 B. Ge et al., “Stomach A prospective randomized controlled trial of laparoscopic repair versus open repair for perforated peptic ulcers.”
 H. A. Wadaani, “Emergent laparoscopy in treatment of perforated peptic ulcer: A local experience from a tertiary centre in Saudi Arabia,” World J. Emerg. Surg., vol. 8, no. 1, Mar. 2013.
 A. Motewar, M. Tilak, D. S. Patil, N. Bhamare, and L. Bhople, “Laparoscopic versus open management of duodenal perforation: A comparative study at a District General Hospital,” Prz. Gastroenterol., vol. 8, no. 5, pp. 315–319, 2013.
 S. L. Siow, H. A. Mahendran, C. M. Wong, M. Hardin, and T. L. Luk, “Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique,” Asian J. Surg., vol. 41, no. 2, pp. 136–142, Mar. 2018.
 V. Golash, “Ten-Year Retrospective Comparative Analysis of Laparoscopic Repair versus Open Closure of Perforated.,” Oman Med. J., vol. 23, no. 4, pp. 241–6, Oct. 2008.
 F. H. Shah, S. G. Mehta, M. D. Gandhi, and Saraj, “Laparoscopic Peptic Ulcer Perforation Closure: the Preferred Choice,” Indian J. Surg., vol. 77, no. Suppl 2, pp. 403–406, Dec. 2015.
 S. A. Stepanyan et al., “Laparoscopic and open repair for perforated duodenal ulcer: Single-center experience,” Wideochirurgia I Inne Tech. Maloinwazyjne, vol. 14, no. 1, pp. 60–69, 2019.
 A. Mirabella et al., “Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study,” BMC Surg., vol. 18, no. 1, Sep. 2018.
 K. Thorsen, J. A. Søreide, and K. Søreide, “Scoring systems for outcome prediction in patients with perforated peptic ulcer,” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 21, no. 1. BioMed Central, p. 25, 10-Apr-2013.
 S. Di Saverio et al., “Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper,” World Journal of Emergency Surgery, vol. 9, no. 1. BioMed Central Ltd., p. 45, 03-Aug-2014.
 D. J. Doyle and E. H. Garmon, American Society of Anesthesiologists Classification (ASA Class). StatPearls Publishing, 2018.
 M. Žáček, J. Váňa, and B. Babiš, “Laparoscopic closure of perforated gastro-duodenal ulcer: 15 years’ experience in our centre,” Videosurgery Other Miniinvasive Tech., vol. 4, pp. 578–585, 2014.
 M. H. Jamal et al., “Laparoscopy in Acute Care Surgery: Repair of Perforated Duodenal Ulcer,” Med. Princ. Pract., vol. 28, no. 5, pp. 442–448, Sep. 2019.
 D. J. K. Lee, M. Ye, K. H. Sun, V. G. Shelat, and A. Koura, “Laparoscopic versus Open Omental Patch Repair for Early Presentation of Perforated Peptic Ulcer: Matched Retrospective Cohort Study.,” Surg. Res. Pract., vol. 2016, p. 8605039, 2016.
 A. C. Critchley, A. W. Phillips, S. M. Bawa, and P. V. Gallagher, “Management of perforated peptic ulcer in a district general hospital,” Ann. R. Coll. Surg. Engl., vol. 93, no. 8, pp. 615–619, Nov. 2011.
 M. F. Çelik et al., “Erken başvurulu peptik ülser perforasyonu olgularinda laparoskopik onarimin artan yeri,” Turkish J. Surg., vol. 30, no. 3, pp. 120–124, 2014.
 P. Budzyński et al., “Changing patterns in the surgical treatment of perforated duodenal ulcer - Single centre experience,” Wideochirurgia I Inne Tech. Maloinwazyjne, vol. 10, no. 3, pp. 430–436, Sep. 2015.
 S. Zogovic, A. B. Bojesen, S. Andos, and F. V. Mortensen, “Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality (a nationwide prospective cohort study),” 2019.
 G. A. Hawker, S. Mian, T. Kendzerska, and M. French, “Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP),” Arthritis Care Res., vol. 63, no. SUPPL. 11, pp. S240–S252, Nov. 2011.
 N. Cui, J. Liu, and H. Tan, “Comparison of laparoscopic surgery versus traditional laparotomy for the treatment of emergency patients,” J. Int. Med. Res., p. 030006051988919, Dec. 2019.
 M. Alemrajabi, S. Safari, A. Tizmaghz, F. Alemrajabi, and G. Shabestanipour, “Laparoscopic Repair of Perforated Peptic Ulcer: Outcome and Associated Morbidity and Mortality,” Electron. physician, vol. 8, no. 6, pp. 2543–2543, Jun. 2016.
 H. Aljohary, H. Althani, G. Elmabrok, K. Hajaji, and I. Taha, “Outcome of laparoscopic repair of perforated duodenal ulcers,” Singapore Med. J., vol. 54, no. 4, pp. 216–219, Apr. 2013.
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