Esophageal Perforation. Laparoendoscopic Management

Jose Daniel Lozada Leon, MD, Ramon Oropeza Martinez, MD, Jose Antonio Tamara Lopez, MD, Clodoalda Durthley Lozada Leon, MD, Fret Carreto Arredondo, MD, Aide Colin Armenta, SN

Santa Monica hospital Cuernavaca, Morelos, Mexico

INTRODUCTION:
The aim of this video is to present the endoscopic management in patients with endoscopic esophageal perforation.

Esophageal perforation is a surgical emergency associated with mortality of 10 to 25% when it resolves within the first 24 hrs and 40 to 60% when treatment is delayed after 48hrs, if there is no mediastinal contamination and/ or septic shock initially the the treatment can be only endoscopic safe

METHODS AND PROCEDURES:
In the period of March 1999 to January 2011 there have been in our surgical team ten esophageal perforations, five male patients (50%) and five female patients (50%), aged between 16 and 75 years, with a median age of 40.3 years, the mechanism of injury was hurst instrumentation probe during intraoperative laparoscopic floppy Nissen fundoplication in six patient, and one patient in the inmediate postoperative antireflux procedure drilled during attempted nasogastric tube placement in a health center, one patient with esophageal leak after postoperative period of resection of esophageal diverticulum by disruption of the mechanical line suture, one patient with esophageal perforation by tear of the first stich of the floppy nissen fundoplication, and one patient with esophageal perforation during heller surgical procedure.

RESULTS
four patients were managed with total esophageal exclusion and enteral feeding and in a second surgical time reconstruction using Laparoendoscopic antiperistaltic left colon as the other six patients were managed conservatively endoscopically with the use of clips resolution, tisucol and stent, and endoscopic gastrostomy for feeding, three patients had fistula salivary (75%), two closed conservatively and one patient (25%) required re intervention, the patients in whom we perform endoscopic management were hospital discharge at six day and the patients with esophageal exclusion at thirteenth day, in this patients we observed that the perioperative weight loss was of 16.2 kg on average, they were to a second surgical time 80 days after esophageal exclusion, we performed antiperistaltic left colon transposition, in one transmediastinal, in two retrosternal and in one subcutaneous approach, with hospital stay of 5 days in the reconstructive surgery. all patients are alive

CONCLUSIONS:
The choice of treatment for a patient with esophageal perforation should be individualized in each case in particular being able to offer endoscopic conservative management or aggressive surgical treatment in case that required. but the main factor of which depends that is the time of diagnosis.

in case were the patient with esophageal perforation required surgical treatment the Early aggressive surgical treatment is the only way to give the opportunity of life to these patients

Session: Poster Presentation

Program Number: P266