title: Surgical management of Boerhaave's syndrome in a tertiary oesophagogastric centre.
abstract: BACKGROUND
  The aim of this study was to review the management and outcome of patients with Boerhaave's syndrome in a specialist centre between 2000-2007.
  
  
  METHODS
  Patients were grouped according to time from symptoms to referral (early, < 24 h; late, > 24 h). The effects of referral time and management on outcomes (oesophageal leak, reoperation and mortality) were evaluated.
  
  
  RESULTS
  Of 21 patients (early 10; late 11), three were unfit for surgery. Of the remaining 18, immediate surgery was performed in 8/8 referred early and 6/10 referred late. Four patients referred late were treated conservatively. Oesophageal leak (78% versus 12.5%; P < 0.05) and mortality (40% versus 0%; P < 0.05) rates were higher in patients referred late. For patients referred late, mortality was higher in patients managed conservatively (75% versus 17%; not significant).
  
  
  CONCLUSIONS
  The best outcomes in Boerhaave's syndrome are associated with early referral and surgical management in a specialist centre. Surgery appears to be superior to conservative treatment for patients referred late.
authors.affiliation: Department of Surgery, St Thomas' Hospital, London, UK.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sutcliffe
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Forshaw
authors.forename: Gourab
authors.initials: G
authors.lastname: Datta
authors.forename: Ashish
authors.initials: A
authors.lastname: Rohatgi
authors.forename: Dirk C
authors.initials: DC
authors.lastname: Strauss
authors.forename: Robert C
authors.initials: RC
authors.lastname: Mason
authors.forename: Abraham J
authors.initials: AJ
authors.lastname: Botha
mesh_terms: D000368:Aged; D004322:Drainage; D004939:Esophageal Perforation / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008480:Mediastinitis / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011859:Radiography; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012086:Reoperation; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D018805:Sepsis / Q000209:etiology*; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome