title: Reinforced primary repair of early distal oesophageal perforation.
abstract: OBJECTIVE
  To describe our surgical technique for, and results of, reinforced primary repair in benign distal oesophageal perforation in early cases.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary care hospital, Kuwait.
  
  
  METHODS
  15 patients with iatrogenic or traumatic benign distal oesophageal perforation.
  
  
  METHODS
  Primary repair with reinforcement using pleura, pericardial flap, or gastric fundus. Of the 3 patients with achalasia, 2 had oesophagomyotomy alone and 1 had oesophagomyotomy with fundoplication. Associated distal obstruction caused by reflux stricture was treated by dilatation and fundoplication in 1 patient.
  
  
  METHODS
  The causes of perforation, presence of underlying oesophageal disease, time to operation, postoperative leakage, mortality, and follow-up.
  
  
  RESULTS
  Perforation was caused by instrumentation in 10 patients, trauma in 3, and ingested foreign bodies in 2. 6 patients had pre-existing oesophageal diseases: achalasia in 3, hiatus hernia in 2, and reflux stricture in 1. 10 patients presented within 12 hours, and 5 patients more than 12 hours after the perforation. 4 postoperative leaks developed. One patient perforated a stress gastric ulcer and then developed pneumonia and died of multiple organ failure. At follow-up, all 14 surviving patients were able to eat a normal diet. 2 patients who had gastric fundus used as a reinforcement tissue developed mild gastro-oesophageal reflux and oesophagitis. Both responded to medical treatment.
  
  
  CONCLUSIONS
  Primary repair and tissue reinforcement of benign distal oesophageal perforation is safe in early cases and obviates the need for a second operation.
authors.affiliation: Department of Surgery, Faculty of Medicine, Kuwait University, Safat.
authors.forename: A K
authors.initials: AK
authors.lastname: Ayed
authors.forename: H J
authors.initials: HJ
authors.lastname: Al-Din
authors.forename: S K
authors.initials: SK
authors.lastname: Asfar
mesh_terms: D000293:Adolescent; D000328:Adult; D013505:Digestive System Surgical Procedures; D004939:Esophageal Perforation / Q000601:surgery*; D018662:Fundoplication; D005748:Gastric Fundus / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010994:Pleura / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps