LAPAROSCOPIC VS. OPEN SURGERY FOR PERFORATED PEPTIC ULCER: COMPARISON OF POSTOPERATIVE OUTCOMES

Abstract

Perforated peptic ulcer is a surgical emergency associated with high morbidity and mortality, mainly due to peritonitis, sepsis, and progressive physiological deterioration. Although open surgery remains widely used, laparoscopic treatment has gained increasing acceptance because of its potential to reduce surgical trauma and postoperative complications. This study aimed to compare the main postoperative outcomes associated with laparoscopic and open surgery for perforated peptic ulcer. An integrative literature review was conducted using PubMed/MEDLINE, Scopus, Web of Science, LILACS, and SciELO, with priority given to studies published between 2020 and 2026. Observational studies, clinical trials, systematic reviews, and meta-analyses directly comparing the two surgical approaches were analyzed. The findings indicated that laparoscopic repair is associated with lower rates of surgical-site complications, shorter hospital stays, reduced postoperative pain, and, in some recent pooled analyses, lower mortality. However, outcomes regarding repair-site leakage, intra-abdominal abscess, reoperation, respiratory complications, and operative time remain less consistent. Observational studies have also suggested better functional recovery and quality of life following laparoscopic surgery. Patient selection, hemodynamic stability, perforation size and location, surgical expertise, and resource availability directly influence the choice of technique. In conclusion, laparoscopic repair offers relevant advantages in appropriately selected patients, although superiority has not been demonstrated across all postoperative outcomes. Open surgery remains essential, particularly in hemodynamically unstable patients, when technical limitations are present, or when rapid control of abdominal contamination is required.