Thoracoscopic primary esophageal repair in patients with Boerhaave's syndrome

Abstract

Background: Early diagnosis and appropriate treatment are important for a good outcome in Boerhaave's syndrome. The results of recent studies suggest that primary esophageal repair should be performed for perforations, and some authors suggest that there are benefits from thoracoscopic surgery in cases that are diagnosed early.

Methods: From December 2004 to May 2010, 15 patients with Boerhaave's syndrome presented to our department; the medical records were reviewed retrospectively for preoperative signs and symptoms, interval between perforation and surgery, surgical methods, and outcomes of treatment. The patients were divided into two groups according to the surgical approach (thoracoscopy versus thoracotomy) to evaluate the outcomes of thoracoscopic surgery in patients with Boerhaave's syndrome.

Results: All patients were men, with a mean age of 53.1 years, and all underwent primary esophageal repair. Seven patients underwent a thoracoscopic approach (group A) and eight patients had a thoracotomy (group B). The mean interval between perforation and surgery was 43.5 hours (group A) and 40.2 hours (group B) (p=0.487). The mean operative time was 3.7 hours (group A) and 5.3 hours (group B) (p=0.005). Postoperative leaks were confirmed by esophagography in one patient in group A and in two patients in group B. There was no mortality in group A and one death postoperatively in group B.

Conclusions: The results of this study suggest that thoracoscopic esophageal repair may be a good surgical alternative in patients with Boerhaave's syndrome who have a relatively stable vital sign or mild inflammation, regardless of the time interval between perforation and surgery.