Kalyan Gorantla, MD, MBA, Seeyuen Lee, MD, MPH. University of Texas at Houston/Houston Northwest Medical Center
Background: Boerhaave’s syndrome, or effort rupture of the esophagus, is a life-threatening emergency and fatal if left untreated. It is associated with high morbidity and mortality often due to a delay in diagnosis. Given the critical nature of the disease, prompt surgical management is recommended. The management traditionally involved controlling sepsis with laparotomy, thoracotomy, or both to repair the site of esophageal perforation and mediastinal debridement/drainage. Since esophageal perforations, and specifically Boerhaave’s syndrome, are uncommon, ideal management guidelines have not been standardized. The authors present a case where a multi-modal minimally invasive approach was used to address the problem of Boerhaave’s syndrome.
Methods: Initial experience of managing Boerhaave’s syndrome in a multidisciplinary manner using laparoscopic, thoracoscopic (VATS), and endoscopic techniques is reported.
Results: Emergent laparoscopic Nissen fundoplication with transabdominal drainage of mediastinum and feeding jejunostomy was utilized to initially treat a patient with Boerhaave’s syndrome. VATS was subsequently utilized to treat a left-sided pleural effusion and empyema. A persistent leak was then managed endoscopically with an esophageal stent. The patient recovered, the stent was removed, and the patient was discharged by hospital day 24. At 8 weeks follow-up, the patient developed symptoms of dysphagia due to an esophageal stricture. The patient underwent endoscopic balloon dilation of the stricture. At 3 month follow-up, the patient was tolerating a diet and gaining weight with no signs of dysphagia.
Conclusion: A multi-modal minimally invasive approach to treating Boerhaave’s syndrome is feasible. Using a combination of laparoscopic, thoracoscopic, and endoscopic approaches can potentially mitigate the morbidity and mortality of open esophageal surgery. Further studies need to be conducted to evaluate and potentially standardize approaches to treating Boerhaave’s syndrome incorporating minimally invasive techniques.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95649
Program Number: P014
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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