Post-operative Outcomes of Laparoscopic Versus Open Repair of Perforated Duodenal Ulcer: A Systematic Review

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.