Slovenská chirurgia 4/2012

Current management of perforated peptic ulcer – what is the evidence?

Aims: To assess current management of perforated peptic ulcer based on the best available evidence. Material and methods: Potentially relevant studies were identified searching Medline database (using mesh terms “laparoscopic“ OR “ulcer“ AND “laparoscopic” OR “open”). Analysis of content was performed in order to synthetize the best available evidence. Results: Overall 50 relevant literature sources were analyzed including randomized controlled trials, meta-analyses, prospective and retrospective clinical cohort studies, review articles and recommendations and guidelines of professional societies. Conclusions: Optimal treatment strategy in patients with perforated peptic ulcer is surgery supported by conservative management. Further multicentric randomized controlled trials with high quality design are needed to confirm expected advantages of miniinvasive approach. SILS and NOTES techniques should be limited to safety and feasibility clinical studies.

Keywords: peptic ulcer, perforated ulcer, laparoscopy, laparoscopic surgery, evidence based medicine.