title: Esophageal stents for less invasive treatment of mediastinitis.
abstract: BACKGROUND
  In spite of the progress in diagnosis and therapeutic options, esophageal perforation resulting in mediastinitis is a very serious condition with a high morbidity.
  
  
  OBJECTIVE
  To evaluate the use of esophageal stents for the treatment of patients suffering from mediastinitis.
  
  
  METHODS
  Retrospective (2008-2012) analysis of a group of patients requiring surgical treatment. The evaluation was focused on the cause of perforation, stent type and its parameters, the surgical method used, duration of stenting and total length of treatment.
  
  
  RESULTS
  In total, 16 patients were treated by stenting. All patients were treated with the stent being placed across the defect in the esophagus. Mediastinitis was accessed and drained with the aid of a thoracotomy or thoracolaparotomy (8 cases), or using a combination of a laparotomy/laparostomy and pleural drainage (5 cases). The most basic interventions were either pleural or external cervical drainage (3 and 1 cases, respectively). One patient, in whom a stricture had developed at the healed perforation, was subjected to esophageal resection. Four patients died. The average period that the stent was left in situ was 53.7 days. The average period of hospitalization of those patients who survived was 53.4 days.
  
  
  CONCLUSIONS
  Using stents in therapy neither increased survival (mortality of 25%), nor decreased the length of therapy of patients once mediastinitis had developed. The main advantage of stenting is the preservation of the native esophagus and the reduced extent of surgical mediastinal drainage.
authors.affiliation: Department of Surgery, Charles University, Teaching Hospital, Plzen, Czech Republic.
authors.forename: Jarmil
authors.initials: J
authors.lastname: Safranek
authors.affiliation: Department of Surgery, Charles University, Teaching Hospital, Plzen, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Geiger
authors.affiliation: Department of Surgery, Charles University, Teaching Hospital, Plzen, Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Vesely
authors.affiliation: Department of Surgery, Charles University, Teaching Hospital, Plzen, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Vodicka
authors.affiliation: Department of Surgery, Charles University, Teaching Hospital, Plzen, Czech Republic.
authors.forename: Vladislav
authors.initials: V
authors.lastname: Treska
keywords: esophageal perforation; esophageal stent; mediastinitis
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