title: Thoracoscopic and Laparoscopic Esophagectomy in a Case of Spontaneous Rupture of the Esophagus (Boerhaave's Syndrome).
abstract: Spontaneous barogenic rupture of the esophagus is a rare disease with high morbidity and mortality. Many therapeutic options are available. Esophagectomy is indicated when a large rupture is found with huge mediastinal contamination. Here, we describe a minimal invasive esophagectomy procedure for an esophageal barogenic rupture. A thoracoscopic esophagectomy was performed with the patient in a prone position. After a laparoscopic gastric tubulization, a cervical esopagho-gastro anastomosis was performed with a retro-sternal passage of the stomach in order to avoid the heavily contaminated posterior mediastinum. The postoperative outcome was almost uneventful. This minimal-invasive approach allowed direct optimal visualization of the esophageal laceration and a thorough mediastinal cleansing, thereby avoiding any septic complications, which are the major concern in this particular clinical procedure. In our case, the esophagectomywas mandatory because of the large laceration and massive mediastinal contamination. The minimal invasive thoracoscopic and laparoscopic esophagectomy approach is feasible even in an emergency setting. This is the first report of this procedure being used in a high-risk patient with Boerhaave's syndrome.
authors.affiliation: Department of Surgery, Alessandria National Hospital, Via Venezia 16, 15100, Alessandria, Italy. gspinoglio@ospedale.al.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spinoglio
authors.forename: Massimo
authors.initials: M
authors.lastname: Summa
authors.forename: Raoul
authors.initials: R
authors.lastname: Quarati
authors.forename: Silvio
authors.initials: S
authors.lastname: Testa
authors.forename: Fabio
authors.initials: F
authors.lastname: Priora
authors.forename: Matteo Luca
authors.initials: ML
authors.lastname: Lenti
authors.forename: Feruccio
authors.initials: F
authors.lastname: Ravazzoni
authors.affiliation: Department of Surgery, Alessandria National Hospital, Alessandria, AL, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Piscioneri
keywords: Abdominal; Thoracic and abdominal
references.citation: Ann Surg. 1997 Apr;225(4):415-21
references.pmid: 9114801
references.citation: Ann Thorac Surg. 2003 Apr;75(4):1071-4
references.pmid: 12683539
references.citation: J Chir (Paris). 2006 Jul-Aug;143(4):237-42
references.pmid: 17088727
references.citation: J Thorac Cardiovasc Surg. 1970 Jan;59(1):67-83
references.pmid: 5409955
references.citation: Ann Thorac Surg. 1998 May;65(5):1433-6
references.pmid: 9594880
references.citation: Eur J Cardiothorac Surg. 2004 Apr;25(4):475-9
references.pmid: 15037257
references.citation: Ann Thorac Surg. 1990 Jan;49(1):35-42; discussion 42-3
references.pmid: 2297275
references.citation: Rev Mal Respir. 2001 Oct;18(5):537-40
references.pmid: 11887772
references.citation: Ann Thorac Surg. 1979 May;27(5):404-8
references.pmid: 110275