Post-operative Outcomes of Laparoscopic Versus Open Repair of Perforated Duodenal Ulcer: A Systematic Review
Bibliographic record
Abstract
Perforated duodenal ulcer is a surgical emergency associated with substantial morbidity and mortality. While open repair has long been the standard, laparoscopic repair is increasingly adopted for its minimally invasive advantages. This systematic review, conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and registered with PROSPERO (CRD420251117651), compared outcomes of laparoscopic versus open repair in adult patients with perforated duodenal ulcers. A comprehensive search of PubMed, Embase, and the Cochrane Library identified comparative studies published between January 2000 and December 2024. Six studies involving 739 patients met the inclusion criteria. Outcomes assessed included operative time, conversion rate, length of hospital stay (LOS), post-operative complications, leak rate, and mortality. Risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB-2) tool for the single randomized controlled trial and the Newcastle-Ottawa Scale for observational studies. Laparoscopic repair was consistently associated with shorter LOS (4.0-7.8 versus 7.8-11.7 days), lower complication rates (5.8-13% versus 8.6-44.3%), and reduced mortality (0-1.8% versus 0-27.9%) compared with open repair, while leak rates were comparable (0-7% versus 1.4-4.9%). Conversion to open surgery occurred in 0-17.8% of laparoscopic cases. Operative times were longer in earlier studies but equivalent or shorter in more recent work. Risk of bias ranged from low to moderate. In conclusion, laparoscopic repair is a safe and effective alternative to open repair, offering a faster recovery and lower morbidity without increasing the risk of leaks. Open repair remains essential for unstable patients or those with severe contamination. Further multicentre randomized trials with standardized outcome reporting are warranted to confirm these benefits and define optimal patient selection.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.033 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.011 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".