TTP5.01 Falciformopexy as an Alternative to Omentopexy in Perforated Peptic Ulcer Repair: A Systematic Review and Meta-analysis

Background Perforated peptic ulcer (PPU) repair commonly utilizes omentopexy, but anatomical constraints may require alternative techniques such as falciformopexy. This systematic review and meta-analysis compare the efficacy and safety of falciformopexy versus omentopexy in PPU repair. Methods A comprehensive literature search was conducted across Web of Science, PubMed, Scopus, and Cochrane Library to identify comparative studies on falciformopexy and omentopexy in adult PPU patients. Pooled risk ratios (RR) and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated for binary and continuous outcomes. Study quality was assessed using the Newcastle-Ottawa Scale. Results Three retrospective cohort studies (n=1089) of good quality were included. Falciformopexy resulted in significantly shorter surgical duration (WMD -7.56 minutes, 95% CI -12.47 to -2.65, P=0.003) and hospitalization (WMD -1.43 days, 95% CI -2.29 to -0.57, P=0.001) compared to omentopexy. However, it was associated with a significantly higher risk of leakage (RR 2.65, 95% CI 1.03 to 6.79, P=0.04) and post-operative ileus (RR 2.85, 95% CI 1.13 to 7.2, P=0.03). No significant differences were found in mortality, re-operation rates, pneumonia, evisceration, or wound infection. Conclusion Falciformopexy may offer advantages in reducing surgical duration and hospitalization length for PPU repair but presents an increased risk of leakage and post-operative ileus. While it serves as a feasible alternative when omentopexy is not viable, further large-scale, randomized controlled trials are needed to validate these findings and guide clinical decision-making.