Surgical Management of Boerhaave's Syndrome in a Tertiary Oesophagogastric Centre

Abstract

The best outcomes in Boerhaave's syndrome are associated with early referral and surgical management in a specialist centre. Surgery appears to be superior to conservative treatment for patients referred late.

Boerhaave’s Syndrome – Over 290 Yrs of Surgical Experiences. Surgical, Endoscopic and Conservative Treatment

“…The site of damage is dressed with a circumferential suture. In this way a perforation may be transformed into a controlled oesophagocutaneous fistula which is closed once the infection subsides (6). There are centres in which this procedure is performed endoscopically, without the need for a thoracotomy (11).…”

“…The vast extent of chemical and bacterial infection and the delay of treatment represent a good basis for rapid development of sepsis and subsequent multi-organ failure (MOF). For these reasons, BS should be treated as a lifethreatening condition (6,8,9). The factors which determine not only the manner but also the ultimate outcome of the treatment include time from rupture to repair efforts, the extent of damage and local oesophageal wall lesions.…”

“…Some surgeons believe that early damage is involved during the first 6 hours, at most 12 hours (10,14). The majority of surgeons who treat BS patients accept the borderline of up to 24 hours vs. more (6,15).…”

Surgery for acute mediastinitis in oesophageal perforations and descending necrotising infection: complications, mortality and protective factors

“…Especially depending on the time passed between perforation and surgery; the most frequently used techniques are primary repair with or without plastic surgery, oesophagectomy and oesophageal exclusion. 10,11 In our study, the oesophageal exclusion technique has been carried out since 1997 on those patients in whom the time between perforation and treatment is greater than 12 h. In contrast to other groups, 12 the authors consider oesophageal exclusion to be a safe, effective technique for treating oesophageal perforation and oesophagectomy is reserved for those patients who, in addition to the perforation, have another related oesophageal pathology. We made oesophageal exclusion with nonreabsorbible stapler in both sides of the perforation (7 cases) or superior to the perforation (9 cases).…”

Outcomes following Boerhaave's syndrome

“…Mortality rates in this study compare favourably with those quoted in the literature. 9,10 Rapid surgical intervention is widely recommended, with primary repair where possible. [11][12][13][14] In this study, all patients managed surgically underwent oesophageal repair, either primarily or with Ttube drainage.…”