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J Thorac Cardiovasc Surg 2007;133:840-841
© 2007 The American Association for Thoracic Surgery

Brief Communication

A novel two-stage repair technique for the management of esophageal perforation

Juha Saarnio, MD, PhD, Heikki Wiik, MD, PhD, Vesa Koivukangas, MD, PhD, Timo Heikkinen, MD, PhD, Tatu Juvonen, MD, PhD, Fausto Biancari, MD, PhD*

Department of Surgery, Oulu University Hospital, Oulu, Finland.

Received for publication October 24, 2006; accepted for publication November 28, 2006.

* Address for reprints: Fausto Biancari, MD, PhD, Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, PO Box 21, 90029 Oulu, Finland. (Email: faustobiancari@yahoo.it; fausto.biancari@ppshp.fi).

The first 20% of the full text of this article appears below.


Figure 1
Drs Heikkinen, Juvonen, and Biancari (upper left to right); and Drs Koivukangas, Wiik, and Saarnio (lower left to right)


Esophageal perforation is associated with significant mortality and morbidity. When primary surgical closure of the esophageal tear or its sealing by covered stents is not indicated, a 2-stage procedure with esophagectomy, end-cervical esophagostomy, and gastrostomy followed by reconstruction several months after mediastinitis subsides is considered the safest approach.1-3Go However, preparation of the esophageal substitute and re-establishing esophageal continuity in a scarred posterior mediastinum poses further immediate and late risks to the patient. To reduce the extent of this second operative stage, we recently used a new method for 2-stage esophageal repair: a gastric tube was tunnelled via the posterior mediastinal route during the first procedure and a cervical gastrostomy along with a cervical esophagostomy was constructed. A simple cervical end-to-end esophagogastrostomy was then accomplished a few months later.

Clinical Summaries

Patient 1
. . . [Full Text of this Article]




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[Abstract] [Full Text] [PDF]


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