Laparoscopic transhiatal repair of esophageal rupture in Boerhaave Syndrome is a safe and effective treatment

Abstract

Boerhaave Syndrome, also known as spontaneous esophageal rupture, is a rare condition with an estimated mortality of 20%-40%. Conventional surgical repair with the intention of primary repair remains the mainstay of treatment in esophageal rupture in Boerhaave syndrome. We present our experience with 2 cases that underwent laparoscopic transhiatal repair of esophageal rupture in Boerhaave Syndrome. Both cases presented with left chest and abdominal pain after vomiting, and were normotensive on admission. In both cases, the diagnosis of Boerrhaave Syndrome were made on Computer Tomographic (CT) scan. The patients underwent laparoscopic repair of the esophageal rupture successfully, and were subsequently discharged well on post-operative day 13 and 15 respectively. The laparoscopic transhiatal repair of esophageal rupture in Boerhaave Syndrome results in shorter length of hospital stay. The mean length of stay in the laparoscopic approach was 14 days (13 & 15days) in our series, as opposed to a mean of 20.5 days in patients who underwent open thoracotomy and washout with primary repair. There were no mortalities in either of the patients who underwent laparoscopic transhiatal repair in our series, however open thoracotomy and primary repair was associated with a mortality of 20%. The rarity of a ruptured esophagus makes comparison between the various treatment methods difficult. From our own experience and successful outcome in 2 such patients, we conclude that laparoscopic transhiatal repair of Boerhaave syndrome is a safe alternative to open repair in patients as the rupture often occurs in the lower end of the esophagus, provided there are no contraindications to laparoscopy.

Three Cases of Boerhaave’s Syndrome Treated via Laparoscopic Transhiatal Esophageal Repair

“…Two patients followed a good postoperative course, but 1 patient subsequently succumbed to multi-organ failure. Since then, Kimberley et al [ 6 ], Yeo et al [ 7 ], Hayakawa et al [ 8 ], and Aiolfi et al [ 9 ] have reported a total of 5 cases of Boerhaave's syndrome repaired by only laparoscopic surgery via the transhiatal route. There were no reports of mortality, and good postoperative results were obtained, except for the early case of Landen and El Nakadi [ 5 ] (Table 1 ) [ 6 , 7 , 8 , 9 ].…”

“…Since then, Kimberley et al [ 6 ], Yeo et al [ 7 ], Hayakawa et al [ 8 ], and Aiolfi et al [ 9 ] have reported a total of 5 cases of Boerhaave's syndrome repaired by only laparoscopic surgery via the transhiatal route. There were no reports of mortality, and good postoperative results were obtained, except for the early case of Landen and El Nakadi [ 5 ] (Table 1 ) [ 6 , 7 , 8 , 9 ]. When performing the laparoscopic esophageal repair via the transhiatal route, avoiding penetrating the pleura is vital as it is important not to spread the inflammation in the thoracic cavity.…”

Minimally invasive surgical management of Boerhaave’s syndrome: a narrative literature review

“…The mainstay of treatment is pleural and mediastinal debridement combined with esophageal repair and spillage prevention (24). Esophageal wall closure may be achieved via primary suture with patch reinforcement or over a T-tube drainage to create a controlled esophagocutaneous fistula (12)(13)(14)(15)(16)(17). Major resection with or without primary reconstruction has been described but is matter of debate especially in defeated and septic patients (4).…”