Minimally invasive approach to Boerhaave’s syndrome

Landen, S; Nakadi, Issam El

doi:10.1007/s00464-001-9185-4

Cited by 48 publications

(38 citation statements)

References 10 publications

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“…We support the opinion of other researchers that diagnosis can be made earlier and more accurate with CT scan [10,11], because the use of CT with contrast may expedit the diagnosis even in critically ill patients with atypical symptoms which might impede rapid identification of esophageal perforation. More over we consider, that up today CT scans may be useful not only for study of fluid and air collections, the extent of a surrounding inflammatory process but it can precisely enough localize the site of the perforation before VATS surgery and illustrate the postoperative healing of a esophageal perforation.…”

Section: Discussionsupporting

confidence: 87%

Diagnosis, management and outcomes of thoracic esophageal perforation

Panko¹,

Karpitski²,

Shestjuk³

et al. 2014

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Introduction: Esophageal perforation has been considered a catastrophic and often life-threatening event.Aim of the research: To show the results and difficulties in the management of esophageal perforation based on the experience of our department of thoracic surgery as well as data obtained from other hospitals. Material and methods: We performed a retrospective analysis of the management of 103 patients (mean age: 49.4 ±3.1) treated during the period of 1997-2011. Open surgery historical control group (94 patients) was compared with patients (9 cases) who had undergone video-assisted thoracoscopic surgery nonresection procedure in our hospital. Results: Data analysis has revealed that 32 (31%) of all patients were not recognized as a "thoracic esophageal injury" at the first examination. Despite the fact that more than 80% of patients were hospitalized on the first day, in 42 cases (40.8%), surgical treatment was applied after 24 h (52.1 ±7.8). Sixty-percent patients of control group were complicated by postoperative morbidity resulted in higher (p < 0.05) mortality rate (35.1%) and hospital stay time (41.2 ±6.1 days), then VATS management of patients who had 11.1% postoperative mortality and 26.5 ±5.6 days of hospital stay. Conclusions: Esophageal perforations are rare pathology and due to the rarity of this condition and its often nonspecific presentation, the surgical treatment of it is delayed in more than 40% of patients, which leads to death of every third patient. Video-assisted thoracoscopic surgery with adequate drain perforation has had advantages in comparison with standard open surgical techniques in treatment of patients with delayed perforation and severe inflammatory reaction.

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Section: Discussionsupporting

confidence: 87%

Diagnosis, management and outcomes of thoracic esophageal perforation

Panko¹,

Karpitski²,

Shestjuk³

et al. 2014

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“…In any case, given the limited experience and the lack of long-term follow-up data so far with this indication-spontaneous esophageal perforation-stents should be used with caution. Clearly, there must be technical improvements such as biodegradable prostheses and data from long-term experience before endoscopic stenting might safely and effectively replace primary surgical repair as the frontline treatment for Boerhaave's syndrome, as suggested by Landen and El Nakadi [11]. In the largest report so far, with 19 cases treated, the use of an endoscopic stent was compared with surgery in nine patients- [18].…”

Section: Discussionmentioning

confidence: 98%

“…To date, there are only four reports of minimally invasive surgical management of Boerhaave's syndrome via either laparoscopy or thoracoscopy [10][11][12][13]. Given that spontaneous esophageal perforation usually involves the left lateral aspect of the distal esophagus just above the diaphragm, Landen and El Nakadi [11] suggest a laparoscopic transhiatal route to access easily the damaged portion of the esophagus.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of middle thoracic esophagus: thoracoscopic treatment

et al. 2010

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Spontaneous rupture of the esophagus (so-called Boerhaave's syndrome) is considered a medical emergency. It carries a significant mortality rate and requires prompt treatment. The treatment of choice involves surgical repair of the esophageal defect, usually accomplished via laparotomy, thoracotomy, or both to accomplish esophageal repair and mediastinal debridement. We have treated an elderly patient with severe comorbidities with a minimally invasive approach, achieving a successful complete repair. Long-term endoscopic and radiologic follow-up confirm the good results.

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“…Furthermore, gastrostomy or enterostomy creation is useful for patients in this condition, which is associated with a high rate of postoperative anastomotic leakage, so that enteral nutrition can be given postoperatively 16) . In recent years, there have been scattered reports of treatment of spontaneous esophageal rupture by video-assisted thoracoscopic surgery (VATS) 21) . VATS is minimally invasive and associated with reduced surgical wound infection, but reports suggest that evacuation of intrathoracic contaminants may be insufficient and that a high level of skill is required to suture the esophageal rupture wound.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

Mikami

Fukunaga

Enomoto

et al. 2015

J St. Marianna Univ

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Spontaneous esophageal rupture is rare. The distal esophagus ruptures upon a sudden vomiting-induced increase in the internal esophageal pressure. We evaluated surgical management of spontaneous esophageal rupture by examining clinical details and outcomes of 10 patients treated for the disorder at our hospital between 1987 and 2014.Mean age of the patients was 58.1 years (range, 41-75 years). The sex ratio (M/F) was 9/1. Diagnosis was achieved by chest computed tomography (CT) or chest CT and esophagography. The rupture occurred in the left lower thoracic esophagus (n=8), left middle thoracic esophagus (n=1), or right lower thoracic esophagus (n=1). Mean time from symptom onset to surgery was 36.2 hours (range, 5-96 hours).Patients were divided between those treated within 24 hours of onset (early treatment group, n=5) and those treated 24 hours or more after onset (late treatment group, n=5). Treatment comprised primary repair in 7 patients and esophagectomy in 3. Postoperative complications occurred in 6 patients: surgical site infection (n=4), anastomosis leakage (n=3), intrapleural abscess (n=1), sepsis (n=1), and pneumonia (n=1). Mean postoperative hospital stay was78.5 days (range, 22-228 days). There was no in-hospital mortality.Postoperative complications were somewhat more frequent in the late treatment group (n=4, 80%) than in the early treatment group (n=3, 60%), and postoperative hospital stay was longer in this group (114.2 vs. 42.8 days). Outcomes in terms of postoperative complications and hospital stay were good in the early treatment group. In the late treatment group, severe intrathoracic contamination in 3 patients necessitated life-saving esophagectomy. When primary repair was performed, the incidence of anastomotic leakage was lowest when both layers were sutured, perforation sites were reinforced, and nutritional support was provided.Early diagnosis and treatment are essential for spontaneous esophageal rupture, and we believe that selecting the appropriate surgical technique increases survival.

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Minimally invasive approach to Boerhaave’s syndrome

Abstract: Boerhaave's syndrome is amenable to minimally invasive techniques. Avoidance of a formal thoracotomy with its resulting morbidity could be of considerable benefit to these critically ill patients.

Cited by 48 publications

References 10 publications

Diagnosis, management and outcomes of thoracic esophageal perforation

Diagnosis, management and outcomes of thoracic esophageal perforation

Spontaneous rupture of middle thoracic esophagus: thoracoscopic treatment

Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

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