| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1998;65:1433-1436
© 1998 The Society of Thoracic Surgeons
a Department of Surgery, Postgraduate Medical University, Budapest, Hungary
Accepted for publication December 12, 1997.
Address reprint requests to Dr Altorjay, Department of Surgery, Postgraduate Medical University, Károly krt 23, H-1075 Budapest, Hungary
Background. Despite the many advancements made in thoracic surgery, the management of patients with esophageal perforation remains problematic and controversial.
Methods. Between 1985 and 1995, 27 esophagectomies were performed for perforation of the thoracic esophagus. A retrospective review of the records of these patients was carried out, and a scoring scale developed by Elebute and Stoner to grade the severity of sepsis was applied.
Results. Among the 27 patients undergoing esophagectomy for a perforation, the interval between rupture and esophagectomy was less than 24 hours in only 11 patients (40.7%). Postoperative surgical complications occurred in 4 patients (14.8%) and nonsurgical complications, in 7 (25.9%). The hospital mortality rate was 3.7% (1/27). In 14 patients, primary reconstruction was performed in the bed of the excised esophagus. There were no anastomotic leaks in this subgroup. This suggests that an anastomosis between viable, well-vascularized tissues is more important for successful healing than avoidance of some degree of contamination of the adjacent mediastinum. On follow-up, which averages 41 months, 73% of patients (16/22) have neither symptoms nor complaints.
Conclusions. Esophageal resection definitively eliminates the source of intrathoracic sepsis, the perforation, and the affected esophagus. Reconstruction carried out in one stage does not increase operative morbidity. Esophageal resection and reconstruction is a valid approach even in cases of spontaneous perforation in which the diagnosis is markedly delayed.
This article has been cited by other articles:
|
|
 |
|
  E. Teh, J. Edwards, J. Duffy, and D. Beggs Boerhaave's syndrome: a review of management and outcome Interactive CardioVascular and Thoracic Surgery, October 1, 2007; 6(5): 640 - 643. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. K. Freeman, J. M. Van Woerkom, and A. J. Ascioti Esophageal Stent Placement for the Treatment of Iatrogenic Intrathoracic Esophageal Perforation Ann. Thorac. Surg., June 1, 2007; 83(6): 2003 - 2008. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Jougon, T. Mc Bride, F. Delcambre, A. Minniti, and J.-F. Velly Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment Eur. J. Cardiothorac. Surg., April 1, 2004; 25(4): 475 - 479. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Brinster, S. Singhal, L. Lee, M. B. Marshall, L. R. Kaiser, and J. C. Kucharczuk Evolving options in the management of esophageal perforation Ann. Thorac. Surg., April 1, 2004; 77(4): 1475 - 1483. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.D. Muir, J. White, J.A. McGuigan, K.G. McManus, and A.N. Graham Treatment and outcomes of oesophageal perforation in a tertiary referral centre Eur. J. Cardiothorac. Surg., May 1, 2003; 23(5): 799 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. B. Zwischenberger, C. Savage, and A. Bidani Surgical Aspects of Esophageal Disease . Perforation and Caustic Injury Am. J. Respir. Crit. Care Med., April 15, 2002; 165(8): 1037 - 1040. [Full Text] [PDF]
|
|
|
|
|
|
F. V. DiPierro, T. W. Rice, M. M. DeCamp, L. A. Rybicki, and E. H. Blackstone Esophagectomy and staged reconstruction Eur. J. Cardiothorac. Surg., June 1, 2000; 17(6): 702 - 709. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
