Primary closure versus Graham patch omentopexy in perforated peptic ulcer: A systematic review and meta-analysis

There are different methods to repair a perforated peptic ulcer, the two most frequently used are the Graham patch omentopexy and the primary closure. Currently there is no high-level evidence to provide guidance of the optimal method of repair. The aim of this study is to compare the outcomes of the two methods so as to provide improved guidance for surgeons undertaking this repair. A systematic review and meta-analysis was conducted including any study that compared Graham patch omentopexy with primary closure in adults. Embase, Medline, Cochrane and Google's search engine were searched. The primary outcome was breakdown of the repair resulting in bile leak and the secondary outcomes were mortality, operation time, wound infection and time to start oral intake. The meta-analysis was conducted using Review Manager Software version 5:4. Outcome data were reported as odd ratios and weighted mean differences with their 95% confidence intervals. Of the 229 studies identified, 6 were suitable for analysis, 4 were retrospective, one was a prospective cohort study and one was a randomized controlled trial. Meta-analysis showed no difference in occurrence of bile leak or mortality between primary closure and Graham patch omentopexy (OR 0.64; 95% (0.26–1.54) & 0.66; 95% (0.25–1.76) respectively). There was no difference in the rates of wound infection OR 0.65; 95% (0.4–1.05). The duration of the operation was shorter in the primary closure group by 5.6 min; 95% (−21 + 10.4). There was no difference in the clinical outcomes between the two modes of repair. •Perforated PUD represents 0.48% of all emergency surgical admissions in the UK.•This is the first meta-analysis to compare primary closure and GPO.•Primary closure and GPO are equally safe for small perforated peptic ulcers.