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Douglas J. Mathisen
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Ann Thorac Surg 1995;60:245-249
© 1995 The Society of Thoracic Surgeons

Articles

Reinforced primary repair of thoracic esophageal perforation

MD Cameron D. Wright*, MD Douglas J. Mathisen, MD John C. Wain, MD Ashby C. Moncure, MD Alan D. Hilgenberg, MD Hermes C. Grillo

General Thoracic Surgical Unit, Massachusetts General Hospital, and Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA

* Address reprint requests to Dr Wright, Massachusetts General Hospital, Warren 1212, Boston, MA 02114.

Background.: Treatment of esophageal perforation, especially when diagnosed late, remains controversial.

Methods.: Twenty-eight patients were treated for thoracic esophageal perforation with reinforced primary repair regardless of time of presentation.

Results.: Fifteen patients were treated early (<24 hours) with no deaths. Two had contained postoperative leaks, which healed. Thirteen were treated late (mean, 5.5 days) with four deaths (3 with healed repairs). Postoperative leaks occurred in 7 patients; of the leaks, 4 healed, 2 became a controlled fistula, and 1 required reoperation. Primary healing with preservation of the native esophagus was achieved in 25 patients (89%). Among the 18 patients without evidence of sepsis preoperatively, postoperative leaks developed in 2 (11%). Ten patients had evidence of sepsis preoperatively, and postoperative leaks developed in 7 (70%).

Conclusions.: Patients who present with sepsis have an increased risk of postoperative leak and therefore should have the repair buttressed. Overall mortality was 14% and no deaths were due to persistent leaks or mediastinal sepsis. Reinforced primary repair retains the native esophagus and avoids the need for later reconstructive operations. In the absence of a nondilatable stricture or cancer, reinforced primary repair should be performed for most thoracic esophageal perforations, early or late.




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