Conservative surgical management of Boerhaave's syndrome: Experience of two tertiary referral centers

• Published in: International journal of surgery (London, England) Vol. 11; no. 1; pp. 64 - 67
• Main Authors: Sulpice, L, Dileon, S, Rayar, M, Badic, B, Boudjema, K, Bail, J.P, Meunier, B
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2013; Elsevier
• Subjects: Aged; Boerhaave's syndrome; Conservative surgery; Digestive System Surgical Procedures; Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - methods; Esophageal Perforation; Esophageal Perforation - surgery; Female; France; Human health and pathology; Humans; Hépatology and Gastroenterology; Life Sciences; Male; Mediastinal Diseases; Mediastinal Diseases - surgery; Middle Aged; Retrospective Studies; Surgery; Suture Techniques; Tertiary Care Centers; Tertiary Care Centers - statistics & numerical data; France; Boerhaave's syndrome; Conservative surgery
• ISSN: 1743-9191; 1743-9159
• DOI: 10.1016/j.ijsu.2012.11.013

Abstract Background Surgery is generally proposed for Boerhaave's syndrome, spontaneous rupture of the esophagus. But diagnosis can be difficult, delaying appropriate management. The purpose of the present study was to evaluate outcome of conservative surgery for primary or T-tube repair performed in two tertiary referral centers. Methods From June 1985 to November 2010, among 53 patients presenting with Boerhaave's syndrome treated surgically, 39 underwent a conservative procedure. These patients were retrospectively divided into two groups by type of repair: primary suture (group 1, n  = 25) or suture on a T-tube (group 2, n  = 14). Patients in group 1 were further stratified into two subgroups depending on whether the primary suture was made with reinforcement (subgroup rS) or not (subgroup S). Results Length of stays in hospital and intensive care were shorter in patients in group 1 ( p  = 0.037), but after a shorter delay before therapeutic management ( p  = 0.003) compared with group 2. For the other variables studied, outcome was more favorable in group 1, but the differences were not significant. Comparing subgroups rS and S showed that the rate of persistent leakage was significantly lower after reinforced suture ( p  = 0.021). Conclusions These findings from the largest reported cohort of Boerhaave's syndrome patients undergoing conservative surgery showed that primary and T-tube repair provide at least equivalent results. Reinforced sutures appear to provide better outcomes by reducing postoperative leakage.