Long-term observation and functional state of the esophagus after primary repair of spontaneous esophageal rupture.
BACKGROUND
Long-term outcome of patients treated for a spontaneous esophageal rupture (Boerhaave's syndrome) is seldom reported.


METHODS
From 1989 to 2004, 62 esophageal perforations were treated in a single institution. Eighteen patients presented with a spontaneous esophageal rupture. Among them, 15 could be treated with a transthoracic primary repair and constituted the material of the present study. A chart review was performed with special attention to survival, residual symptoms, and anatomic and motility disorders.


RESULTS
Three patients died postoperatively (20%). At last follow-up, 10 patients were alive and 2 had died from unrelated causes. At a median delay of 13 months (3 to 74), 7 patients accepted to undergo complementary investigations. None of them had any anatomic abnormality as checked by barium swallow. Six patients complained of mild symptoms from gastroesophageal reflux. Six patients (85%) presented with esophageal motility disorders on manometry and 4 (54%) had nocturne chronic reflux disease on pH monitoring. Two patients underwent endoscopic ultrasonography, of which one presented with a focal absence of one layer of the esophageal wall within the area of the suture. With time, no patient experienced recurrence, but one developed a cancer in the cervical esophagus.


CONCLUSIONS
These results suggest that esophageal functional disorders are the rule after primary repair of a Boerhaave's syndrome. Whether or not these findings are causal, coincidental, or related to the surgical treatment remains unclear. However, performance of routine postoperative explorations is strongly encouraged for a better understanding of this challenging condition.
D'Journo
Xavier Benoit
XB
Department of Thoracic Surgery, Ste. Marguerite University Hospital, Marseille, France.
Doddoli
Christophe
C
Avaro
Jean Philippe
JP
Lienne
Pascal
P
Giovannini
Marc A
MA
Giudicelli
Roger
R
Fuentes
Pierre A
PA
Thomas
Pascal A
PA
D000368:Aged; D004935:Esophageal Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D016896:Treatment Outcome