Treatment of esophageal perforation in a referral center in taiwan.
OBJECTIVE
The high mortality associated with esophageal perforation can be reduced by aggressive surgery and good critical care. We report our experience of treating esophageal perforation in a clinic in Taiwan.


METHODS
The subjects were 28 patients who underwent surgery for a benign esophageal perforation.


RESULTS
The esophageal perforation was iatrogenic in 11 patients, spontaneous in 8, and caused by foreign body injury in 9. Most (22/28) of the patients were seen longer than 24 h after perforation, and 77% had empyema preoperatively. The perforation was located in the cervical area in 5 patients and in the thoracic esophagus in 23. We performed primary repair in 24 patients, esophagectomy in 3, and drainage in 1. Leakage occurred after primary repair in ten (41%) patients, resulting in one death, and two patients died of other diseases. Postoperative leakage prolonged the hospital stay but had no impact on mortality. Overall survival was 90%. Univariate analysis revealed that age, timing of treatment, and cause and location of the perforation influenced outcome, but multivariate analysis failed to identify a predictor of mortality.


CONCLUSIONS
Early diagnosis and intervention are crucial to prevent morbidity and mortality in patients with esophageal perforation. Primary repair is feasible even if the diagnosis is delayed.
Chao
Yin-Kai
YK
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan 333, Taipei, Taiwan.
Liu
Yun-Hen
YH
Ko
Po-Jen
PJ
Wu
Yi-Cheng
YC
Hsieh
Ming-Ju
MJ
Liu
Hui-Ping
HP
Lin
Pyng Jing
PJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002423:Cause of Death; D004322:Drainage / Q000379:methods; D004630:Emergencies; D004939:Esophageal Perforation / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011336:Probability; D011859:Radiography; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome