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Ann Thorac Surg 1996;61:1451-1452
© 1996 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 300 words of the full text of this article appear below.

See also page 1447.

DR HAROLD C. URSCHEL, JR, (Dallas, TX): Thank you, Dr Bufkin, for a very clear presentation. Our approach back in the early 1960s was very similar to that presented here, with the exception of the T tube. When we saw a fairly early large perforation and repaired it primarily, reinforcing it with pleura or intercostal bundle or even occasionally omentum, we would still see leaks in a certain percentage of patients secondary to that repair. Because of that, in the mid-1960s we began to use exclusion and diversion on all the larger esophageal perforations regardless of the time we saw them, early or late, and the ones that we basically could not treat conservatively.

This procedure involves preventing a continued chemical burn from the stomach. We exclude the esophagus below the perforation after we close the perforation. We close it either with pleura, the intercostal bundle, or with omentum. We started with Teflon, and now we use Silastic. We tie it with either chromic or, if we want to bring out a Rumel tourniquet, with Prolene or something like that and bring it out below the diaphragm with a gastrostomy.

We do this in every case regardless of how secure it looks because we can never trust the situation completely. At the same time, we do a side-to-side cervical esophagostomy to the skin. Although this is side to side, it provides 100% diversion because of the angulation of the esophagus.

The advantage of this technique is that the patients can usually go home in a week, and they do not need a second general anesthetic. If you use a chromic tie, this comes undone by itself in about 3 weeks. If you use the Rumel, you can release it in about 3 weeks. You can close . . . [Full Text of this Article]

Related Article

Esophageal Perforation: Emphasis on Management

Bradley L. Bufkin, Joseph I. Miller, Jr, and Kamal A. Mansour
Ann. Thorac. Surg. 1996 61: 1447-1451. [Abstract] [Full Text]