Evidence map›Paper›PMID 40911086›Full record

SynthesisLangenbeck's archives of surgery2025

Approaches for the treatment of perforated peptic ulcers: a network meta-analysis of randomized controlled trials.

Elisabeth Wadewitz, Juliane Friedrichs, Maurizio Grilli, Johannes A Vey, Samuel Zimmermann, Yoshiaki Sunami, Jörg Kleeff, Ulrich Ronellenfitsch, Johannes Klose, Artur Rebelo

Abstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Langenbeck's archives of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Elisabeth WadewitzDepartment of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin Luther University Halle Wittenberg, Halle, Germany.
Juliane FriedrichsDepartment of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin Luther University Halle Wittenberg, Halle, Germany.
Maurizio GrilliLibrary of the Medical Faculty Mannheim, Mannheim, Germany.
Johannes A VeyInstitute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany.
Samuel ZimmermannInstitute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany.
Yoshiaki SunamiDepartment of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin Luther University Halle Wittenberg, Halle, Germany.
Jörg KleeffDepartment of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin Luther University Halle Wittenberg, Halle, Germany.
Ulrich RonellenfitschDepartment of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin Luther University Halle Wittenberg, Halle, Germany.
Johannes KloseDepartment of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin Luther University Halle Wittenberg, Halle, Germany.
Artur RebeloDepartment of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin Luther University Halle Wittenberg, Halle, Germany. artur.rebelo@uk-halle.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis network meta-analysis (NMA) aims to evaluate surgical and alternative treatment strategies for perforated peptic ulcers (PPU) with respect to mortality and other clinically relevant outcomes.

methodsAn NMA was conducted in accordance with PRISMA guidelines to assess treatment approaches for PPU. Randomized controlled trials (RCT) were identified through systematic searches of PubMed/MEDLINE, Cochrane Library, Embase, CINAHL, ClinicalTrials.gov, and ICTRP databases. Outcomes were analyzed using standardized mean differences (SMDs) for continuous data and odds ratios (ORs) for binary data, both presented with 95% confidence intervals (CI) in a network meta-analysis framework.

resultsSixteen studies comprising 1,259 patients were included in this NMA. The laparoscopic approach demonstrated significantly reduced mortality (OR 0.36, 95% CI 0.17-0.75, p = 0.0065) and postoperative complications, including wound infections (OR 0.15, 95% CI 0.08-0.27, p < 0.0001) and ileus (OR 0.33, 95% CI 0.18-0.59), compared to the open surgical approach.

conclusionsThis NMA, particularly the pairwise analysis, confirms the significant advantages of laparoscopic over open surgery, reinforcing its status as the gold standard for PPU. The potential benefits of alternative approaches, are inconclusive due to insufficient evidence.

Indexed as

LaparoscopyPeptic Ulcer PerforationHumansPostoperative ComplicationsRandomized Controlled Trials as TopicTreatment OutcomeEmergency surgeryNetwork meta-analysisPerforated peptic ulcersTreatment approaches

Identifiers

PMID40911086
PMCPMC12413338

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.