title: Thoracoscopic repair of instrumental perforation of the oesophagus: first report.
abstract: BACKGROUND
  Perforation of the oesophagus is a life-threatening condition requiring early recognition and repair to prevent mediastinitis and death. Primary closure with mediastinal drainage is recognised as the treatment of choice for patients presenting within 24 hours. Many are frail, however, and unsuitable for major surgery.
  
  
  OBJECTIVE
  To report the first case of thoracoscopic repair of the oesophagus for oesophageal perforation following instrumentation.
  
  
  METHODS
  Flexible endoscopy revealed a 10cm perforation in the right lower oesophagus. With the gastroscope in the oesophagus, four thoracoports were introduced. Using suction and irrigation, the pleural cavity was suctioned free of debris and a 10cm longitudinal tear of the right lateral aspect of the oesophagus was repaired using interrupted polyglactin sutures through all layers.
  
  
  RESULTS
  The patient tolerated the procedure well and made an uncomplicated recovery.
  
  
  CONCLUSIONS
  The uncomplicated recovery of this frail patient without need for blood transfusions or assisted ventilation supports the notion that the thoracoscopic approach may have significant advantages. With increased experience and technical refinements there should be less reluctance to refer these patients for earlier definitive surgical repair.
authors.affiliation: Department of Surgery, Mercy Hospital, Cork, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Collins
authors.forename: M
authors.initials: M
authors.lastname: Arumugasamy
authors.forename: J
authors.initials: J
authors.lastname: Larkin
authors.forename: S
authors.initials: S
authors.lastname: Martin
authors.forename: G C
authors.initials: GC
authors.lastname: O'Sullivan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004939:Esophageal Perforation / Q000209:etiology / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects; D004947:Esophagus; D005260:Female; D005547:Foreign Bodies; D016330:Frail Elderly; D006801:Humans; D007049:Iatrogenic Disease; D011677:Punctures; D013537:Sutures; D013906:Thoracoscopy