Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment

Abstract

Long free interval before treatment does not preclude primary esophageal repair in Boerhaave's syndrome. Esophageal exclusion may be more often than not avoided in most cases.

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies

“…Surgery remains the mainstay of treatment; the conventional operative approach is considered to be primary repair of the perforation site and drainage. [7][8][9] Some surgeons advocate primary repair only for those patients presented within 24 hours of perforation, 10 while others would try primary repair as the initial treatment regardless of the timing of presentation. 9,11 Endoscopic treatment, including stenting, is becoming an increasingly popular means of treating oesophageal perforation in selected patients, and reportedly has a high technical success rate.…”

“…[7][8][9] Some surgeons advocate primary repair only for those patients presented within 24 hours of perforation, 10 while others would try primary repair as the initial treatment regardless of the timing of presentation. 9,11 Endoscopic treatment, including stenting, is becoming an increasingly popular means of treating oesophageal perforation in selected patients, and reportedly has a high technical success rate. [12][13][14][15][16] Oesophageal perforation should be managed in specialised centres.…”

“…9,11,21,22 Leak rates after primary repair range from 17% to 32%. 9,11,[21][22][23][24] Minor leaks can be managed conservatively with drainage, while further surgery (usually exclusion) is required for larger leaks and in the presence of sepsis. Lin et al 23 reported that the incidence of postoperative leak was 37.5% in patients in whom treatment was delayed for more than 48 hours, compared with 0% in those who were treated more promptly.…”

“…Contamination with food particles is common. Operative treatment with primary closure of the perforation and drainage is favoured by many [7][8][9] ; this is also our preferred approach. Many surgeons advocate primary repair irrespective of the timing of presentation.…”

Extension injury of the thoracic spine with rupture of the oesophagus and successful conservative therapy of concomitant mediastinitis

“…If undiscovered, an oesophageal perforation inevitably results in mediastinitis and sepsis. The mortality rate of this condition is up to 40% [4,11,12,14,16,18,22]. Cherveniakov et al [6] emphasise the importance of early treatment, and report a delayed diagnosis due to failure to recognise the clinical symptoms in 55% and due to misinterpretation of X-ray findings in another 25% in their series of 147 patients.…”