To the Editor, I read the systematic review regarding laparoscopic repair of perforated peptic ulcer by Bertleff and Lange [1] with great interest. At first glance, it appears that open repair was better in terms of re-operation and time taken. However, on careful evaluation done by the authors, it becomes apparent that the re-operation rate was high in randomised control trials where an omental patch was not used to repair the perforation. While fashioning an omental patch is an essential part of an open repair, why this should not be the case when performing a laparoscopic procedure is beyond comprehension. Higher re-operation rates were not seen in the trial routinely using omental patch. This indicates that the higher re-operation rates in these trials are not due to the laparoscopic approach itself, but are a result of the method of repair. Furthermore, the time taken for a laparoscopic repair was indeed less than that of an open repair when performed in high-volume centres [2]. In addition, laparoscopic approach offers the benefit of thorough pelvic washout under vision compared with an upper midline or right sub-costal incisions in an open operation.
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