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Ann Thorac Surg 2006;81:1858-1862
© 2006 The Society of Thoracic Surgeons

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Original article: General thoracic

Long-Term Observation and Functional State of the Esophagus After Primary Repair of Spontaneous Esophageal Rupture

^a Department of Thoracic Surgery, Ste. Marguerite University Hospital, Marseille, France
^b Unité Propre de Recherche et d'Enseignement Supérieur, Equipe d'Acceuil (UPRES EA 2001), Institut Fédératif de Recherche, Jean Roche, Marseille, France
^c Endoscopic Unit, Paoli-Calmettes Institute, Marseille, France

Accepted for publication December 13, 2005.

^_* Address correspondence to Dr Thomas, Department of Thoracic Surgery, Ste Marguerite Hospital-CHU Sud, 270 Bd Ste Marguerite, 13274 Marseille Cedex 9, France (Email: pascal-alexandre.thomas{at}mail.ap-hm.fr).

BACKGROUND: Long-term outcome of patients treated for a spontaneous esophageal rupture (Boerhaave's syndrome) is seldom reported.

METHODS: From 1989 to 2004, 62 esophageal perforations were treated in a single institution. Eighteen patients presented with a spontaneous esophageal rupture. Among them, 15 could be treated with a transthoracic primary repair and constituted the material of the present study. A chart review was performed with special attention to survival, residual symptoms, and anatomic and motility disorders.

RESULTS: Three patients died postoperatively (20%). At last follow-up, 10 patients were alive and 2 had died from unrelated causes. At a median delay of 13 months (3 to 74), 7 patients accepted to undergo complementary investigations. None of them had any anatomic abnormality as checked by barium swallow. Six patients complained of mild symptoms from gastroesophageal reflux. Six patients (85%) presented with esophageal motility disorders on manometry and 4 (54%) had nocturne chronic reflux disease on pH monitoring. Two patients underwent endoscopic ultrasonography, of which one presented with a focal absence of one layer of the esophageal wall within the area of the suture. With time, no patient experienced recurrence, but one developed a cancer in the cervical esophagus.

CONCLUSIONS: These results suggest that esophageal functional disorders are the rule after primary repair of a Boerhaave's syndrome. Whether or not these findings are causal, coincidental, or related to the surgical treatment remains unclear. However, performance of routine postoperative explorations is strongly encouraged for a better understanding of this challenging condition.

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