title: Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment.
abstract: OBJECTIVE
  Boerhaave's syndrome is the most sinister cause of esophageal perforation responsible with mortality rate ranging from 20 to 30%. Combination of mediastinal contamination with microorganisms, gastric acid and digestives enzymes, long free interval between injury and initiation of treatment causes severe mediastinitis which is fatal in most untreated cases. The aim of this paper is to emphasize primary esophageal repair and resuscitation whatever the free interval from rupture and repair.
  
  
  METHODS
  A retrospective review of patients treated for Boerhaave's syndrome in our department from January 1980 to February 2003 was performed. The principle of treatment was surgical treatment and avoidance of esophageal exclusion or esophagectomy whichever was possible.
  
  
  RESULTS
  There were 25 patients (17 males and 8 females). All patients were operated on by primary esophageal repair, except for three who underwent immediate exclusion of the esophagus and one patient who deceased on arrival before being operated. Patients were classified according to free interval between perforation and treatment: group 1 (n=9; 36%) within the 24 h (range from 12 to 24 h) and group 2 (n=16; 64%) more than 24 h (range from 2 to 17 days). Altogether 6 patients deceased (24%). In hospital mortality rate for groups 1 and 2 was, respectively, 44% (four patients) and 13% (two patients), not significantly different. Mean hospital stay was 63 days. Two patients developed anastomotic leakage needing esophagectomy and retrosternal coloplasty in one or more steps. One patient developed pleural abscess treated by percutaneous drainage. Three patients presented temporary symptomatic esophageal stenosis, of whom one underwent dilation.
  
  
  CONCLUSIONS
  Long free interval before treatment does not preclude primary esophageal repair in Boerhaave's syndrome. Esophageal exclusion may be more often than not avoided in most cases.
authors.affiliation: Department of Thoracic Surgery, Haut-Lévêque Hospital, Bordeaux University Hospital, avenue de Magellan, 33604 Pessac, France. jacques.jougon@chu-bordeaux.fr
authors.forename: Jacques
authors.initials: J
authors.lastname: Jougon
authors.forename: Tarun
authors.initials: T
authors.lastname: Mc Bride
authors.forename: Frédéric
authors.initials: F
authors.lastname: Delcambre
authors.forename: Antonio
authors.initials: A
authors.lastname: Minniti
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Velly
mesh_terms: D000328:Adult; D000368:Aged; D004939:Esophageal Perforation / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D016019:Survival Analysis; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome