Minimally invasive approach to Boerhaave's syndrome: a pilot study of three cases.
BACKGROUND
Boerhaave's syndrome requires urgent thoracotomy, laparotomy, or both for esophageal repair and pleuromediastinal debridement. Minimally invasive techniques may be suitable alternatives.


METHODS
Over a period of 12 months, three patients with spontaneous esophageal perforations after forceful vomiting were treated by a combination of minimally invasive techniques including laparoscopy, thoracoscopy, mediastinoscopy, and endoscopic stenting.


RESULTS
Esophageal repair was performed transhiatally via laparoscopy using primary suture, primary suture reinforced by a fundic patch, and fundic patch alone in one patient each. One patient had a second perforation of the proximal esophagus, which was sutured through a cervical incision. This patient successfully underwent secondary endoscopic stenting for a persistent esophageal fistula. Mediastinal debridement was performed transhiatally and also by means of a mediastinoscope introduced via the cervical incision in one patient. One patient required secondary thoracoscopic debridement of a pleural empyema but died of sepsis after 1 month. The two other patients recovered and were discharged from the hospital after 2 and 8 weeks, respectively.


CONCLUSIONS
Boerhaave's syndrome is amenable to minimally invasive techniques. Avoidance of a formal thoracotomy with its resulting morbidity could be of considerable benefit to these critically ill patients.
Landen
S
S
Department of Surgery, St. Elisabeth Hospital, Avenue De Fré 206, 1180 Brussels, Belgium.
El Nakadi
I
I
D000368:Aged; D004724:Endoscopy / Q000379:methods; D004935:Esophageal Diseases / Q000601:surgery*; D004947:Esophagus / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010865:Pilot Projects; D012422:Rupture, Spontaneous / Q000601:surgery*; D015607:Stents; D013577:Syndrome; D013906:Thoracoscopy / Q000379:methods