[Videothoracoscopic treatment of esophageal perforation].
BACKGROUND
Esophageal perforation can within hours result in seriously-ill patients with a high risk of complications. The array of treatment options is many and minimal invasive methods are emerging.


METHODS
Six patients with esophageal perforations, who were managed successfully by thoracoscopic debridement, irrigation and drainage. The causes of the lesions and the importance of early diagnosis are described. The different treatment schemes are outlined, and the specifics of this thoracoscopic approach are described. The importance of port placement is underlined and illustrated in Figure 1.


RESULTS
The six patients with a median age of 70.5 years (29-80) were successfully treated with videothoracoscopic debridement, irrigation with saline and drainage. Median time in surgery was 91.5 min. and the in-hospital time was 17.5 days. There were no complications except for one patient with continuous bacterial contamination of the pleural cavity, necessitating chest tube treatment for weeks after discharge. No patient was re-operated nor had a fatal course.


CONCLUSIONS
The potential applications of thoracoscopic surgery as a minimal invasive treatment for esophageal perforations are discussed, as well as the advantages of a combination of videothorascopic drainage and placement of a covered expandable stent. This combination must be evaluated in future studies.
Christensen
Merete
M
Gentofte Hospital, Thoraxkirurgisk Afdeling R, Hellerup.
Petersen
René Hornsleben
RH
Hansen
Henrik Jessen
HJ
D000328:Adult; D000368:Aged; D003646:Debridement; D004322:Drainage; D004939:Esophageal Perforation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012307:Risk Factors; D015607:Stents; D007507:Therapeutic Irrigation; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome