Thoracic esophageal perforations: surgical management with mechanical bipolar exclusion.
We report 12 cases of thoracic esophageal perforation diagnosed during the last seven years. Management was nonsurgical in 2 patients and the rest were treated surgically. Primary repair and drainage were performed in 2 patients, and 7 patients underwent suture of the perforation and bipolar exclusion using nonresorbable staples. The remaining patient was treated with proximal unipolar exclusion. The approach was always through a posterolateral thoracotomy. The result was optimal in 8 patients; the most important postsurgical complications were 2 esophageal fistulas that required surgery, and only one of the patients died of fulminating sepsis. Bipolar exclusion is a procedure that needs only one operation and provides excellent morbidity-mortality rates compared with other exclusion techniques with later reconstruction. We consider suturing with nonresorbable staples to be a simple and safe procedure, with spontaneous recanalization of the esophageal lumen in 2 weeks.
Gironés Vilá
J
J
Servicio de Cirugía General y Digestiva, Hospital de Girona Dr. J. Trueta, Girona 17007, España.
Sebastián Quetglas
F
F
Roig García
J M
JM
Farrés Coll
R
R
Rodríguez Hermosa
J I
JI
Tuca Rodríguez
F
F
Fernández Gutiérrez
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013536:Suture Techniques