title: A successful strategy for surgical treatment of Boerhaave's syndrome.
abstract: BACKGROUND
  This retrospective single-institution study presents a successful treatment strategy for Boerhaave's syndrome.
  
  
  METHODS
  During 1995-2008, 15 patients with spontaneous esophageal perforation were treated. Patients were grouped according to time from symptoms to referral (early, <24 h; late, >24 h). In group I (early, n = 8 patients) treatment comprised primary surgical esophageal repair in seven cases and endoscopic clipping in one case. In group II (late, n = 7 patients) treatment comprised esophagectomy without primary reconstruction (4 cases) or controlled esophagocutaneous fistula (3 cases). Measures of outcome included age (years), delay to diagnosis (h), severe sepsis on admission, mortality, and hospital and intensive care unit (ICU) stay.
  
  
  RESULTS
  The overall hospital mortality rate was 6.6% (1/15), being 0% (0/8) in group I and 14.2% (1/7) in group II. Patient age (49.6 vs. 68.6 years, P < 0.0001), delay to diagnosis (17.75 vs. 69 h, P < 0.0001), severe sepsis on admission (0 vs. 4, P = 0.0256), and ICU stay (4 vs. 14 days, P = 0.006) were all greater in group II.
  
  
  CONCLUSIONS
  Early diagnosis and carefully selected therapeutic tactics can reduce the mortality rate of Boerhaave's syndrome to an acceptably low level. Methods of organ preservation and minimally invasive techniques can be applied successfully in the treatment.
authors.affiliation: Department of Surgery, Albert Szent-Györgyi Medical Center, University of Szeged, Pécsi u. 6, Szeged 6720, Hungary. lg@surg.szote.u-szeged.hu
authors.forename: György
authors.initials: G
authors.lastname: Lázár
authors.forename: Attila
authors.initials: A
authors.lastname: Paszt
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Simonka
authors.forename: Anett
authors.initials: A
authors.lastname: Bársony
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Abrahám
authors.forename: Gábor
authors.initials: G
authors.lastname: Horváth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004939:Esophageal Perforation / Q000601:surgery*; D016629:Esophagectomy; D004944:Esophagoplasty; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000601:surgery*; D008875:Middle Aged; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation