Surgical Management of Esophageal Perforation: Role of Esophageal Conservation in Delayed Perforation

Abstract

Definitive repair of esophageal perforation is considered the preferred treatment for patients presenting early (<24 hours). However, the optimal management of delayed presentation (>24 hours) has not been well defined. This study examined the management of esophageal perforation and compared the outcomes of early versus delayed presentation. Records of patients admitted with the diagnosis of esophageal perforation were reviewed. Contrast studies were used to confirm the diagnosis in all cases. Patient demographics and outcome were analyzed to determine differences between early and delayed presentation. A total of 22 cases of esophageal perforation were identified (eight early vs 14 delayed presentations). Operative interventions included primary repair (four), reinforced repair (14) either with intercostal muscle or pleural flap, and a complete esophageal resection (one). Debridement and drainage without repair were done in two patients and a proximal intramural tear was treated with antibiotics and observation. Two patients died during hospitalization. All surviving patients had near-normal restoration of esophageal function. Follow-up at 3 years has shown minimal gastrointestinal problems. One patient required repeat esophageal dilatations and two patients underwent antireflux therapy. Esophageal repair should be considered in all cases of nonmalignant esophageal perforation and should not be influenced by the time of presentation.

Current Treatment and Outcome of Esophageal Perforations in Adults: Systematic Review and Meta‐Analysis of 75 Studies

“…The literature search yielded 1,142 studies. After review, 75 studies [2, 7–80] were found to be pertinent to this issue, with sources of information on 2,971 patients undergoing any treatment of esophageal perforation (Fig. 1).…”

How to Treat Esophageal Perforations When Determinants and Predictors of Mortality Are Considered

“…In individual cases, this indication was extended for longer than 24 h for smaller lesions. Moreover, to back up this finding excellent results have been reported for using this technique [11, 12, 18, 20, 24, 27, 29, 30].…”

Manejo conservador de la perforación esofágica

“…Para plantear una reparación primaria del esófago se deben cumplir varios requisitos como son un esófago previamente sano, lograr un debridamiento completo del tejido comprometido alrededor de la perforación que generalmente se logra en perforaciones con menos de 24 horas de evolución, realizar una técnica adecuada y lograr un correcto drenaje e irrigación del área contaminada [21][22][23][24][25][26] . Ya que esta técnica conlleva una alta morbilidad principalmente debido a su alto porcentaje de fístulas, se han ideado distintas técnicas de refuerzo de la sutura con parches sintéticos o con tejido vecino vital como son los colgajos musculares o pleurales entre otros 21, 22 .…”