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Ann Thorac Surg 1995;59:1216
© 1995 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

Harold C. Urschel, Jr, MD

1201 Barnett Tower 3600 Gaston Ave Dallas, TX 75246

See also page 1214.

This report confirms our previous observation of ``spontaneous recanalization'' after esophageal exclusion distal to the perforation. This has been observed after exclusion by Teflon felt, and absorbable and nonabsorbable ligatures. The spontaneous recanalization usually occurs at about 3 weeks after exclusion and is manifested by gastric regurgitation into the esophagus and subsequent demonstration of patency by proximal flow from above. The explanation for this is not entirely clear.

Esophageal exclusion and diversion should be used more frequently because it is a much less complicated procedure than usually envisioned. It is a good way to treat not only patients in whom the perforation could not be closed but also patients in whom the perforation can be closed but in whom there is some question about healing.

Further investigative work is necessary to determine the frequency of recanalization after total esophageal exclusion by the different techniques and materials, as well as the delineation of its mechanism.


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Spontaneous Recanalization of the Esophagus After Exclusion Using Nonabsorbable Staples
Venki Paramesh, John D. Rumisek, and Frederic C. Chang
Ann. Thorac. Surg. 1995 59: 1214-1215. [Abstract] [Full Text]




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