Reinforced primary repair of thoracic esophageal perforation.
BACKGROUND
Treatment of esophageal perforation, especially when diagnosed late, remains controversial.


METHODS
Twenty-eight patients were treated for thoracic esophageal perforation with reinforced primary repair regardless of time of presentation.


RESULTS
Fifteen patients were treated early (< 24 hours) with no deaths. Two had contained postoperative leaks, which healed. Thirteen were treated late (mean, 5.5 days) with four deaths (3 with healed repairs). Postoperative leaks occurred in 7 patients; of the leaks, 4 healed, 2 became a controlled fistula, and 1 required reoperation. Primary healing with preservation of the native esophagus was achieved in 25 patients (89%). Among the 18 patients without evidence of sepsis preoperatively, post-operative leaks developed in 2 (11%). Ten patients had evidence of sepsis preoperatively, and postoperative leaks developed in 7 (70%).


CONCLUSIONS
Patients who present with sepsis have an increased risk of postoperative leak and therefore should have the repair buttressed. Overall mortality was 14% and no deaths were due to persistent leaks or mediastinal sepsis. Reinforced primary repair retains the native esophagus and avoids the need for later reconstructive operations. In the absence of a nondilatable stricture or cancer, reinforced primary repair should be performed for most thoracic esophageal perforations, early or late.
Wright
C D
CD
General Thoracic Surgical Unit, Massachusetts General Hospital, Boston 02114, USA.
Mathisen
D J
DJ
Wain
J C
JC
Moncure
A C
AC
Hilgenberg
A D
AD
Grillo
H C
HC
D000368:Aged; D004939:Esophageal Perforation / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D013536:Suture Techniques; D013903:Thoracic Surgery / Q000379:methods; D013997:Time Factors