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The following is a summary of “Alternative treatments to treat perforated peptic ulcer: a systematic review and network meta-analysis of randomized controlled trials,” published in the April 2025 issue of World Journal of Emergency Surgery by Gavriilidis et al. 

Perforated peptic ulcers (PPU) were a critical surgical emergency, and although open surgical repair had historically been the primary approach, laparoscopic and endoscopic methods had shown potential for lowering morbidity and the duration of hospital stays.  

Researchers conducted a retrospective study to perform a network meta-analysis comparing open, laparoscopic, and endoscopic interventions for PPU repair.  

They performed a systematic search of Medline (PubMed), Embase, Cochrane Library, Google Scholar, and the National Institute for Health and Clinical Excellence (NICE) databases to identify randomized controlled trials (RCTs) comparing open, laparoscopic, and endoscopic approaches for PPU repair. The primary outcomes assessed were 30-day mortality and morbidity.  

The results showed that 8 RCTs with 657 patients were analyzed. Endoscopic interventions were linked to fewer respiratory complications and a shorter hospital stay. The laparoscopic approach resulted in fewer surgical site infections and less postoperative pain compared to open repair. No significant differences were found across other outcomes between the interventions.  

Investigators concluded that prompt resuscitation and surgical repair, whether laparoscopic or open, remained the established standard for PPU, with endoscopic techniques serving as feasible alternatives for smaller perforations and in specific cases where general anesthesia was not advisable. 

Source: wjes.biomedcentral.com/articles/10.1186/s13017-025-00599-2