HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nan Wang Anees J. Razzouk Karen Gan Glen S. Van Arsdell Michael J. Wood Edwin E. Vyhmeister Changwoo Ahn Steven R. Gundry Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, N. Articles by Gundry, S. R. Search for Related Content PubMed PubMed Citation Articles by Wang, N. Articles by Gundry, S. R.

J Thorac Cardiovasc Surg 1996;111:114-122
© 1996 Mosby, Inc.

GENERAL THORACIC SURGERY

DELAYED PRIMARY REPAIR OF INTRATHORACIC ESOPHAGEAL PERFORATION: IS IT SAFE?

Loma Linda and Fontana, Calif.

Address for reprints: Nan Wang, MD, Assistant Professor of Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Loma Linda University Medical Center, 11234 Anderson St., Loma Linda, CA 92354.

Abstract

The management of intrathoracic esophageal perforation with delayed diagnosis is a subject of controversy. Because of the obvious advantages of primary repair as a simple single-stage operation, this technique was preferentially used to treat 18 of 22 consecutive patients with esophageal perforation. These patients were stratified into three groups according to the time interval between perforation and repair: group A, less than 6 hours, five patients (28%); group B, 6 to 24 hours, six patients (33%); and group C, more than 24 hours, seven patients (39%). Group A patients were older (p < 0.05) and group B had fewer iatrogenic perforations (B, 17%; A, 80%; C, 57%, p < 0.1). Additional tissue was used to buttress the repair site in all three groups (A, 3/5 patients, 60%; B, 4/6 patients, 67%; C, 6/7 patients, 86%; p = not significant). In seven patients (39%), a fundic wrap was used to reinforce the site of primary repair. The outcomes of the three groups were analyzed. Group A had the lowest proportion of postoperative leaks (A, 0/4 patients, 0%; B, 4/6 patients, 67%; C, 5/6 patients, 83%; p < 0.05) and postoperative morbidity (A, 2/5 patients, 40%; B, 6/6 patients, 100%; C, 6/7 patients, 86%; p < 0.1). However the increased incidence of leak and morbidity did not lead to an increase in mortality. One death occurred in each group, with an overall mortality of 17% (A, 1/5 patients, 20%; B, 1/6 patients, 17%; C, 1/7 patients, 14%; p = not significant). We conclude that in the era of advanced intensive care capabilities, primary repair of intrathoracic esophageal perforation can be safely accomplished in most patients regardless of the time interval between perforation and operation. Leakage at the suture site is common unless primary repair is carried out without delay. Postoperative leakage, however, is usually inconsequential and does not necessarily result in an adverse outcome. (J THORAC CARDIOVASC SURG 1996;111:114-22)

This article has been cited by other articles:

				A. W. Kim, M. J. Liptay, N. Snow, P. Donahue, and W. H. Warren Utility of Silicone Esophageal Bypass Stents in the Management of Delayed Complex Esophageal Disruptions Ann. Thorac. Surg., June 1, 2008; 85(6): 1962 - 1967. [Abstract] [Full Text] [PDF]

				P. A. Linden, R. Bueno, S. J. Mentzer, L. Zellos, A. Lebenthal, Y. L. Colson, D. J. Sugarbaker, and M. T. Jaklitsch Modified T-Tube Repair of Delayed Esophageal Perforation Results in a Low Mortality Rate Similar to That Seen With Acute Perforations Ann. Thorac. Surg., March 1, 2007; 83(3): 1129 - 1133. [Abstract] [Full Text] [PDF]

				J. Jougon, T. Mc Bride, F. Delcambre, A. Minniti, and J.-F. Velly Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment Eur. J. Cardiothorac. Surg., April 1, 2004; 25(4): 475 - 479. [Abstract] [Full Text] [PDF]

				C. J. Brinster, S. Singhal, L. Lee, M. B. Marshall, L. R. Kaiser, and J. C. Kucharczuk Evolving options in the management of esophageal perforation Ann. Thorac. Surg., April 1, 2004; 77(4): 1475 - 1483. [Abstract] [Full Text] [PDF]

				J. L. Port, M. S. Kent, R. J. Korst, M. Bacchetta, and N. K. Altorki Thoracic esophageal perforations: a decade of experience Ann. Thorac. Surg., April 1, 2003; 75(4): 1071 - 1074. [Abstract] [Full Text] [PDF]

				M. D. Iannettoni, A. A. Vlessis, R. I. Whyte, and M. B. Orringer Functional Outcome After Surgical Treatment of Esophageal Perforation Ann. Thorac. Surg., December 1, 1997; 64(6): 1606 - 1609. [Abstract] [Full Text]