Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies

Hasimoto, Cláudia Nishida; Cataneo, Cristina; Eldib, Regina; Thomazi, Rafael; Pereira, Rodrigo Severo de Camargo; Minossi, José Guilherme; Catâneo, Antônio José Maria

doi:10.1590/s0102-86502013000400006

Cited by 37 publications

(36 citation statements)

References 33 publications

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“…Non- operative management, in appropriate patients, can be used in selected patients. Similar results were recorded by the Houston group [21] and two recent meta-analyses [22,23]. …”

Section: Injuries To the Thoracic Oesophagussupporting

confidence: 89%

Oesophageal injuries: Position paper, WSES, 2013

et al. 2014

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The oesophagus is a difficult challenge for the surgeon because of its lack of serosal covering, the tenuous, segmental blood supply and the common delay in the diagnosis of injury. Early diagnosis is the key to successful management. Recent introduction of newer, minimally invasive techniques have provided management alternatives for both the normal and the diseased organ that is injured with both early and delayed diagnosis. Surgical anatomyThe oesophagus is a long, muscular organ that begins at the pharyngooesophageal junction at the level of the sixth cervical vertebra. It ends at the gastrooesophageal junction. The area of its origin at the cricopharyngeus muscle is an area of potential injury by the endoscopist or the neophyte anesthesiologist. Passing into the thorax, the oesophagus and the trachea traverse the superior mediastinum behind the great vessels and with a slight curve passes behind the left mainstem bronchus. From this point, the oesophagus curves to the right in the posterior mediastinum, curves back to the left behind the pericardium and crosses the thoracic aorta. Lying anterior to the thoracic aorta, it reaches the abdomen through the oesophageal hiatus of the diaphragm. There is no serosal covering for the structure. The outer layers are composed entirely of longitudinal and circular muscle fibers with squamous epithelium as the mucosal lining. The blood supply is segmental and is derived from branches of the inferior thyroid, bronchial, intercostal arteries and the aorta. Venous drainage is through submucosal channels into a perioesophageal plexus which eventually enters into the inferior thyroid and vertebral veins in the neck, the azygos and hemiazygos veins in the thorax and the left gastric vein in the abdomen.

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“…Non- operative management, in appropriate patients, can be used in selected patients. Similar results were recorded by the Houston group [21] and two recent meta-analyses [22,23]. …”

Section: Injuries To the Thoracic Oesophagussupporting

confidence: 89%

Oesophageal injuries: Position paper, WSES, 2013

et al. 2014

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“…An aggressive surgical approach is believed to be the most effective way to remove the septic focus and prevent further contamination [4,5]. Despite its perceived advantage surgical therapy continues to be associated with high mortality rates [4,5].…”

mentioning

confidence: 99%

“…Despite its perceived advantage surgical therapy continues to be associated with high mortality rates [4,5]. There has also been a growing interest in the use of covered stents to treat esophageal perforations.…”

mentioning

confidence: 99%

The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations

et al. 2015

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“…Diagnosis of an esophageal perforation mainly relies on radiographic evidence. The esophagogram is considered to be the gold standard examination with which to establish the diagnosis of esophageal lesions and can reveal a contrast leak in most cases of esophageal perforation [Hasimoto et al 2013;Kiss, 2008]. It is important to mention that esophagograms can produce false negatives by up to 10-25% [Flynn et al 1989].…”

Section: Resultsmentioning

confidence: 99%