title: Primary esophageal repair for Boerhaave's syndrome.
abstract: BACKGROUND
  Boerhaave's syndrome is the most sinister cause of esophageal perforation. The mediastinal contamination with microorganisms, gastric acid, and digestive enzymes results in a mediastinitis that is often fatal if untreated.
  
  
  METHODS
  We present a series of 21 patients seen in our unit in the 10 years 1987 to 1996. Esophageal repair was performed in 17 (81%) of them. After the resuscitation of the patient in the intensive care unit, our strategy is primary esophageal repair with a single layer of interrupted absorbable sutures combined with mediastinal toilet, mediastinal drainage, and drainage gastrostomy. The majority of patients (12/21) were referred more than 24 hours after perforation.
  
  
  RESULTS
  The mean age of the patients was 60+/-17 years. The mean stay in the intensive care unit was 1.6+/-1.8 days and the median hospital stay, 14 days. There were three deaths, an overall mortality rate of 14.3%.
  
  
  CONCLUSIONS
  When combined with mediastinal toilet, mediastinal drainage, and drainage gastrostomy, primary esophageal repair for Boerhaave's syndrome gives an acceptable mortality and should not be reserved for patients seen within 24 hours after spontaneous rupture.
authors.affiliation: Department of Thoracic Surgery, Harefield Hospital, Middlesex, United Kingdom.
authors.forename: D R
authors.initials: DR
authors.lastname: Lawrence
authors.forename: S K
authors.initials: SK
authors.lastname: Ohri
authors.forename: R E
authors.initials: RE
authors.lastname: Moxon
authors.forename: E R
authors.initials: ER
authors.lastname: Townsend
authors.forename: S W
authors.initials: SW
authors.lastname: Fountain
mesh_terms: D000368:Aged; D004935:Esophageal Diseases / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous / Q000209:etiology / Q000601:surgery*; D013577:Syndrome; D014839:Vomiting / Q000150:complications