Philipp Horvath, MD, Jessica Lange, MD, Dörte Wichmann, MD, Julia Hilbert, MD, Dietmar Stüker, Marty Zdichavsky, MD. University hospital Tübingen, General Surgery
INTRODUCTION: Rupture of the distal esophagus followed by septic mediastinitis is a potentially life threatening event. Purpose of this study was to evaluate the impact of different treatment strategies on patient’s outcome, especially the need for esophagectomy.
METHODS AND PROCEDURES: From 2006 to 2016 in total 40 patients were referred to our institution with perforation of the esophagus. 50% (n=20) suffered from distal perforation due to Boerhaave syndrome and were included in our study. The following parameters were retrospectively analyzed: age, sex, length of hospital stay, length of intensive care treatment, in-hospital mortalitiy, treatment modality (operative, endoscopic or conservative), 90-day morbidity focusing on rate of esophagectomy, presence of stenosis, symptoms of dysphagia and impaired oral food intake.
RESULTS: In total 4 women and 16 men were included. Median age was 70 years (range, 45-85 years). Median length of hospital stay and length of intensive care treatment were 21 days (range, 9-71 days) and 16 days (range, 0-71 days), respectively. All patients received initial or delayed endoscopy (72 endoscopic procedures in 20 patients) and antibiotic and antimycotic treatment. In 16 patients two or more endoscopic interventions were necessary. In 12 patients endoscopic and operative interventions were necessary but in none of the patients distal esophagectomy was required.
Indications for an operative approach were progredient mediastinitis and sepsis. In-hospital mortality was 15% (3/20 patients). These 3 cases were not attributed to the initial esophageal perforation but were due to severe cardiovascvular comorbidities. There was only one patient with stenosis-related symptoms after stent- and endo-sponge treatment.
CONCLUSIONS: Initially endoscopic treatment, either by stent or by endo-sponge, alone or combined with an operative treatment seems feasible in patients suffering from boerhaave-syndrome. If the patient’s clinical situation deteriorates operative interventions either laparoscopically or thoracoscopically are inevitable. In all patients there was no need form distal esophagectomy and only one patient developed scarring with dysphagia requiring ongoing dilatations.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79928
Program Number: S152
Presentation Session: Minimally Invasive Surgery – World Tour
Presentation Type: Podium