title: Adequate debridement and drainage of the mediastinum using open thoracotomy or video-assisted thoracoscopic surgery for Boerhaave's syndrome.
abstract: BACKGROUND
  Boerhaave's syndrome has a high mortality rate (14-40%). Surgical treatment varies from a minimal approach consisting of adequate debridement with drainage of the mediastinum and pleural cavity to esophageal resection. This study compared the results between a previously preferred open minimal approach and a video-assisted thoracoscopic surgery (VATS) procedure currently considered the method of choice.
  
  
  METHODS
  In this study, 12 consecutive patients treated with a historical nonresectional drainage approach (1985-2001) were compared with 12 consecutive patients treated prospectively after the introduction of VATS during the period 2002-2009. Baseline characteristics were equally distributed between the two groups.
  
  
  RESULTS
  In the prospective group, 2 of the 12 patients had the VATS procedure converted to an open thoracotomy, and 2 additional patients were treated by open surgery. In the prospective group, 8 patients experienced postoperative complications compared with all 12 patients in the historical control group. Four patients (17%), two in each group, underwent reoperation. Six patients, three in each group, were readmitted to the hospital. The overall in-hospital mortality was 8% (1 patient in each group), which compares favorably with other reports (7-27%) based on drainage alone.
  
  
  CONCLUSIONS
  Adequate surgical debridement with drainage of the mediastinum and pleural cavity resulted in a low mortality rate. The results for VATS in this relatively small series were comparable with those for an open thoracotomy.
authors.affiliation: Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. janwillemhaveman@gmail.com
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Haveman
authors.forename: Vincent B
authors.initials: VB
authors.lastname: Nieuwenhuijs
authors.forename: Jeroen P Muller
authors.initials: JP
authors.lastname: Kobold
authors.forename: Gooitzen M
authors.initials: GM
authors.lastname: van Dam
authors.forename: John Th
authors.initials: JT
authors.lastname: Plukker
authors.forename: H Sijbrand
authors.initials: HS
authors.lastname: Hofker
mesh_terms: D000328:Adult; D000368:Aged; D003646:Debridement / Q000379:methods*; D004322:Drainage / Q000379:methods*; D004939:Esophageal Perforation / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000601:surgery*; D008482:Mediastinum / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy / Q000379:methods*; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation