Continuous suture versus simple interrupted suture in the laparoscopic repair of peptic ulcer perforation: A systematic review and meta-analysis

doi:10.3877/cma.j.issn.1674-0793.2026.02.012

Abstract

Abstract:

Objective

To compare the efficacy and safety of continuous versus simple interrupted suturing in laparoscopic repair of peptic ulcer perforation.

Methods

Clinical studies comparing the two suturing techniques were searched in Chinese and English databases from the inception to November 13, 2025. After methodological quality assessment and data extraction of the included studies, a meta-analysis was performed using RevMan 5.4 software.

Results

A total of 14 studies (1 randomized controlled trial and 13 observational studies) involving 1 146 patients were included. The overall complication rate (RR=0.56, 95% CI: 0.36, 0.88, P=0.01) and hospital stay (WMD=-0.41, 95% CI: -0.66,-0.16, P=0.001) were significantly lower in the continuous suturing group compared to the interrupted suturing group, with no significant difference in fistula occurrence between the two groups. Subgroup analysis indicated that continuous suturing was faster for perforations with a diameter >0.85 cm. Regarding ulcer healing, continuous suturing was superior to interrupted suturing using silk sutures (RR=1.32, 95% CI: 1.18, 1.47, P<0.000 01), but showed no significant difference when compared to interrupted suturing using absorbable sutures. Continuous suture with absorbable sutures resulted in a shorter gastrointestinal function recovery time compared to interrupted suture with silk sutures, and intraoperative blood loss varied depending on the suture material type.

Conclusions

Continuous suturing for laparoscopic repair of peptic ulcer perforation is safe and feasible, associated with reduced complications and shorter hospital stay. It demonstrates higher suturing efficiency for larger perforations (>0.85 cm), and continuous suturing with absorbable sutures appears more conducive to ulcer healing.

Key words: Peptic ulcer perforation, Laparoscopes, Meta-analysis, Continuous suture, Simple interrupted suture

Fuliang Geng, Kunchao Huang, Zonglin Li, Yunzhou Tian. Continuous suture versus simple interrupted suture in the laparoscopic repair of peptic ulcer perforation: A systematic review and meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(02): 138-144.

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Figures/Tables 12

第一作者及发表年	国家	性别（男/女，例）			年龄（岁， $x ¯$ ±s）			样本量（例）
第一作者及发表年	国家	连续缝合	间断缝合	P值	连续缝合	间断缝合	P值	连续缝合	间断缝合
陈鸿源 2023^［7］	中国	22/8	20/10	0.39	52.50±13.58	53.89±10.93	0.404	30	30
Kim 2021^［8］	韩国	11/14	20/5	0.79	58.4±11.2	56.4±13.5	0.888	15	25
Kim 2018^［9］	韩国	37/14	50/15	>0.05	57.4±19.0	60.8±17.5	>0.05	51	65
Costa 2024^［10］	意大利	30/26	30/26	1.00	63.6±15.1	62.5±15.3	0.715	56	56
陈建明 2025^［11］	中国	15/5	13/7	0.79	50.51±8.24	49.87±8.13	0.30	20	20
马铎 2023^［12］	中国	22/13	21/14	>0.05	59.66±5.44	59.24±5.11	>0.05	35	35
廖梓群 2017^［13］	中国	17/11	20/12	>0.05	47.50±5.40	49.2±6.50	>0.05	28	32
郑荣洁 2020^［14］	中国	未报道			未报道			48	55
郑涛 2022^［15］	中国	20/15	18/11	0.79	42.36±7.09	41.71±6.16	0.67	35	29
刘勇 2020^［16］	中国	24/19	25/18	>0.05	40.31±5.58	40.26±5.64	>0.05	43	43
覃家茂 2019^［17］	中国	27/13	24/16	0.75	46.90±8.20	47.4±7.10	0.669	40	40
燕普 2022^［18］	中国	29/11	26/10	0.99	35.55±1.80	35.89±1.78	0.985	40	36
甘泽林 2021^［19］	中国	48/34	60/42	>0.05	48.10±7.33	48.95±7.62	>0.05	82	102
戴敏 2019^［20］	中国	未报道			未报道			21	34

第一作者及发表年	国家	性别（男/女，例）			年龄（岁， $x ¯$ ±s）			样本量（例）
第一作者及发表年	国家	连续缝合	间断缝合	P值	连续缝合	间断缝合	P值	连续缝合	间断缝合
陈鸿源 2023^［7］	中国	22/8	20/10	0.39	52.50±13.58	53.89±10.93	0.404	30	30
Kim 2021^［8］	韩国	11/14	20/5	0.79	58.4±11.2	56.4±13.5	0.888	15	25
Kim 2018^［9］	韩国	37/14	50/15	>0.05	57.4±19.0	60.8±17.5	>0.05	51	65
Costa 2024^［10］	意大利	30/26	30/26	1.00	63.6±15.1	62.5±15.3	0.715	56	56
陈建明 2025^［11］	中国	15/5	13/7	0.79	50.51±8.24	49.87±8.13	0.30	20	20
马铎 2023^［12］	中国	22/13	21/14	>0.05	59.66±5.44	59.24±5.11	>0.05	35	35
廖梓群 2017^［13］	中国	17/11	20/12	>0.05	47.50±5.40	49.2±6.50	>0.05	28	32
郑荣洁 2020^［14］	中国	未报道			未报道			48	55
郑涛 2022^［15］	中国	20/15	18/11	0.79	42.36±7.09	41.71±6.16	0.67	35	29
刘勇 2020^［16］	中国	24/19	25/18	>0.05	40.31±5.58	40.26±5.64	>0.05	43	43
覃家茂 2019^［17］	中国	27/13	24/16	0.75	46.90±8.20	47.4±7.10	0.669	40	40
燕普 2022^［18］	中国	29/11	26/10	0.99	35.55±1.80	35.89±1.78	0.985	40	36
甘泽林 2021^［19］	中国	48/34	60/42	>0.05	48.10±7.33	48.95±7.62	>0.05	82	102
戴敏 2019^［20］	中国	未报道			未报道			21	34

第一作者及发表年	缝合材料		穿孔部位（十二指肠/胃，例）			穿孔直径（cm）			研究质量评价
第一作者及发表年	连续缝合	间断缝合	连续缝合	间断缝合	P值	连续缝合	间断缝合	P值	研究质量评价
陈鸿源 2023^［7］	2-0倒刺线	2-0抗菌薇乔线	23/7	24/6	0.754	1.15±0.26	1.08±0.30	0.344	Cochran偏倚风险：1条高风险（研究者及受试者未设盲）
Kim 2021^［8］	3-0倒刺线	3-0 抗菌薇乔线	11/4	19/6	0.424	1.2±0.7	1.1±0.6	0.386	NOS 7*
Kim 2018^［9］	3-0倒刺线	3-0 丝线	33/18	41/24	>0.05	0.9±0.5	0.9±0.6	>0.05	NOS 7*
Costa 2024^［10］	倒刺线	未描述	24/32	32/24	>0.05	7.6 ± 2.4	7.8 ± 2.7	0.756	NOS 8*
陈建明 2025^［11］	2-0PDS缝线	2-0PDS缝线	14/6	15/4	0.766	1.21±0.32	1.15±0.40	>0.05	NOS 7*
马铎 2023^［12］	2-0可吸收缝线	2-0 丝线	15/20	16/19	>0.05	0.82±0.27	0.85±0.26	>0.05	NOS 7*
廖梓群 2017^［13］	3-0倒刺线	2-0抗菌薇乔线	13/15	15/17	>0.05	0.8±0.5	0.9±0.4	>0.05	NOS 8*
郑荣洁 2020^［14］	3-0倒刺线	3-0 可吸收线	未报道			未报道			NOS 7*
郑涛 2022^［15］	3-0 可吸收线	3-0 可吸收线	19/16	16/13	0.697	0.89±0.15	0.9±0.15	0.784	NOS 7*
刘勇 2020^［16］	2-0可吸收线	2-0 丝线	16/27	15/28	>0.05	0.79±0.21	0.82±0.23	>0.05	NOS 7*
覃家茂 2019^［17］	2-0可吸收线	2-0 丝线	18/22	21/19	0.54	0.91±0.40	0.84±0.35	0.721	NOS 8*
燕普 2022^［18］	3-0 Quill缝线	3-0 可吸收线	15/25	15/21	0.928	0.85±0.25	0.87±0.27	0.928	NOS 8*
甘泽林 2021^［19］	2-0可吸收线	2-0丝线	45/37	55/47	>0.05	0.88±0.13	0.92±0.15	>0.05	NOS 8*
戴敏 2019^［20］	3-0可吸收线	3-0可吸收线	未报道			0.82±0.09	0.81±0.09	0.451	NOS 7*

References 29

［1］	中华医学会, 中华医学会杂志社, 中华医学会消化病学分会, 等. 消化性溃疡基层诊疗指南(2023年)[J]. 中华全科医师杂志, 2023, 22(11): 1108-1117.
［2］	Sokhal BS, Mohamedahmed A, Zaman S, et al. Laparoscopic versus open repair for peptic ulcer perforation: A systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Time to conclude![J]. Ann R Coll Surg Engl, 2025, 107(5): 331-345.
［3］	Gavriilidis P, Schena CA, Di Saverio S, et al. Alternative treatments to treat perforated peptic ulcer: A systematic review and network meta-analysis of randomized controlled trials[J]. World J Emerg Surg, 2025, 20(1): 31-39.
［4］	陈双. 腹腔镜操作技能基础[M]. 广州：广东科技出版社, 2020: 242–250.
［5］	詹思延, 王聪霞, 孙风, 等. 系统综述与Meta分析[M]. 北京: 人民卫生出版社, 2023: 15–16.
［6］	Wells G. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses[C]. //Symposium on Systematic Reviews: Beyond the Basic. 2024.
［7］	陈鸿源, 池良杰, 王襄瑜, 等. 腹腔镜下采用单向倒刺线缝合行胃十二指肠溃疡穿孔修补术的临床疗效分析[J/OL]. 创伤与急诊电子杂志, 2023, 11(3): 148-152.
［8］	Kim DW, Song S, Jee YS, et al. Duet laparoscopic repair with knotless barbed sutures for treatment of perforated peptic ulcer: reality in general surgery with lacking of manpower[J]. Ann Transl Med, 2021, 9(4): 311-318.
［9］	Kim TH, Park JH, Jeong SH, et al. Feasibility of a novel laparoscopic technique with unidirectional knotless barbed sutures for the primary closure of duodenal ulcer perforation[J]. Surg Endosc, 2018, 32(8): 3667-3674.
［10］	Costa G, Garbarino GM, Lepre LL, et al. Laparoscopic treatment of perforated peptic ulcer: A propensity score-matched comparison of interrupted stitches repair versus knotless barbed suture[J]. J Clin Med, 2024, 13(5): 1242-1254.
［11］	陈建明, 刘其柱. 不同缝合技术对腹腔镜胃十二指肠穿孔修补术疗效的影响[J]. 中华灾害救援医学, 2025, 12(6): 701-709.
［12］	马铎. 不同类型缝线在胃十二指肠溃疡穿孔患者微创修补术中的应用对比[J]. 临床研究, 2023, 31(2): 86-89.
［13］	廖梓群, 陈维荣, 陈喜贵, 等. 倒刺缝线在腹腔镜胃十二指肠溃疡穿孔修补术中的应用[J/OL]. 中华普外科手术学杂志(电子版）, 2017, 11(1): 46-48.
［14］	郑荣洁, 陈国. 倒刺线用于腹腔镜胃十二指肠穿孔修补的应用价值[J/OL]. 临床普外科电子杂志, 2020, 8(1): 6-8.
［15］	郑涛, 马腾, 丁佳佳, 等. 腹腔镜下3种缝合方法在胃十二指肠溃疡穿孔修补术中的应用效果对比[J]. 临床和实验医学杂志, 2022, 21(17): 1845-1848.
［16］	刘勇. 可吸收线对腹腔镜胃十二指肠溃疡穿孔修补术患者术后愈合的影响[J]. 中国校医, 2020, 34(5): 354-356.
［17］	覃家茂, 陆剑萍, 谢文昆, 等. 可吸收线在腹腔镜胃十二指肠溃疡穿孔修补术中的临床应用[J]. 腹腔镜外科杂志, 2019, 24(1): 33-36.
［18］	燕普, 常小伟, 贾环, 等. 三种缝线在腹腔镜胃十二指肠溃疡穿孔修补术中的疗效观察[J]. 肝胆外科杂志, 2022, 30(1): 60-63.
［19］	甘泽林, 艾常华, 庞凌坤, 等. 微创修补术中应用不同类型缝线对胃十二指肠溃疡穿孔患者早期愈合及安全性影响[J]. 临床军医杂志, 2021, 49(5): 573-575.
［20］	戴敏, 张德进, 王晓龙, 等. 腹腔镜下胃十二指肠溃疡穿孔的修补方式选择[J]. 中国内镜杂志, 2019, 25(7): 50-54.
［21］	Kim JK, Lee MJ, Gao B, et al. Comparison of continuous and interrupted suture techniques in pyeloplasty: A systematic review and meta-analysis[J]. Pediatr Surg Int, 2022, 38(9): 1209-1215.
［22］	Baba K, Hozaka Y, Tanabe K, et al. Simultaneous remote laparoscopic training for trainees among multiple institutions: can remote coaching replace on-site coaching?[J]. Asian J Endosc Surg, 2025, 18(1): e70007-70013.
［23］	Chou TC, Lee CH, Soong RS, et al. A simple and effective technique for laparoscopic gastrorrhaphy: modified Graham’s patch with barbed suture[J]. BMC Surg, 2023, 23(1): 295-301.
［24］	赵东峰, 李厚敏, 周庆亮, 等. 缝线类型对胃十二指肠溃疡穿孔患者微创修补术治疗效果的影响[J]. 中国现代药物应用, 2024, 18(3): 6-10.
［25］	李兰, 李雪红, 张艳, 等. 可吸收缝线对输液港置入术后切口愈合的影响及护理配合[J]. 中国美容医学, 2022, 31(5): 166-168.
［26］	Wang X, Liu P, Wu Q, et al. Sustainable antibacterial and anti-inflammatory silk suture with surface modification of combined-therapy drugs for surgical site infection[J]. ACS Appl Mater Interfaces, 2022, 14(9): 11177-11191.
［27］	赵玉沛, 张太平. 普通外科缝合技术的基本原则与缝合材料规范化使用[J]. 中国实用外科杂志, 2019, 39(1): 3-5.
［28］	Polychronidis G, Rahbari NN, Bruckner T, et al. Continuous versus interrupted abdominal wall closure after emergency midline laparotomy: CONTINT: A randomized controlled trial[J]. World J Emerg Surg, 2023, 18(1): 51-60.
［29］	Tominaga GT, Staudenmayer KL, Shafi S, et al. The American Association for the Surgery of Trauma grading scale for 16 emergency general surgery conditions[J]. J Trauma Acute Care Surg, 2016, 81(3): 593-602.

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