Functional outcome after surgical treatment of esophageal perforation.
BACKGROUND
The functional results after treatment of intrathoracic esophageal perforations have been poorly documented.


METHODS
A retrospective review of 42 patients who underwent treatment of intrathoracic esophageal perforation associated with benign esophageal disease was performed.


RESULTS
Of 42 patients treated for esophageal perforation, 25 underwent primary repair, 15 underwent esophagectomy and reconstruction, 1 underwent cervical esophagostomy and drainage followed by esophageal resection, and 1 had drainage alone followed by primary repair. Among the patients treated with primary repair, at least one additional operation was required in 13 patients. Of the 15 patients treated with esophagectomy and reconstruction, none required further operative treatment. Follow-up averaged 3.7 years, and of the 36 survivors available for follow-up, 18 (50%) required at least one esophageal dilation postoperatively, and 3 (8.3%) have required regular dilations. Subjectively, 19 of 36 patients (53%) indicate that their swallowing is better than before perforation, it was the same in 12 (33%), and worse in 4 (11%).


CONCLUSIONS
In conclusion, approximately one third of patients surviving primary repair of esophageal perforations have continued difficulty with swallowing, which often requires esophageal dilations or esophageal reconstructive procedures, or a combination of both. Optimal long-term results are achieved when primary repair is performed in patients with motor disorders or a "normal" esophagus. Esophagectomy is a better option in those patients with strictures or diffuse esophageal disease.
Iannettoni
M D
MD
Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109, USA.
Vlessis
A A
AA
Whyte
R I
RI
Orringer
M B
MB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D004106:Dilatation; D004939:Esophageal Perforation / Q000503:physiopathology / Q000601:surgery*; D016629:Esophagectomy; D004944:Esophagoplasty; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome