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Reinforced primary repair of early distal oesophageal perforation
A K Ayed1, H J Al-Din, S K Asfar
1Department of Surgery, Faculty of Medicine, Kuwait University, Safat.
Insights
Reinforced primary repair is a safe and effective surgical technique for early benign distal esophageal perforations, avoiding the need for repeat operations. This method allows patients to resume a normal diet post-recovery.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Esophageal Surgery
Background:
- Benign distal esophageal perforation presents a significant surgical challenge.
- Early intervention is crucial for optimal outcomes in esophageal perforation.
- Traditional repair methods may have limitations in preventing complications.
Purpose of the Study:
- To detail the surgical technique for reinforced primary repair of benign distal esophageal perforations.
- To evaluate the outcomes and safety of this technique in early-presenting cases.
- To assess the long-term functional results and complication rates.
Main Methods:
- Retrospective study of 15 patients with benign distal esophageal perforation.
- Primary repair reinforced with pleural, pericardial, or gastric fundus grafts.
- Management of associated esophageal diseases like achalasia and reflux stricture.
Main Results:
- Instrumentation was the most common cause of perforation (10 patients).
- 10 patients presented within 12 hours, with 4 postoperative leaks and one mortality.
- All 14 surviving patients achieved a normal diet; 2 experienced mild reflux managed medically.
Conclusions:
- Reinforced primary repair is a safe and effective approach for early benign distal esophageal perforations.
- This technique can obviate the need for secondary surgical interventions.
- Tissue reinforcement enhances the success of primary esophageal repair.
Objective:
To describe our surgical technique for, and results of, reinforced primary repair in benign distal oesophageal perforation in early cases.
Design:
Retrospective study.
Setting:
Tertiary care hospital, Kuwait.
Patients:
15 patients with iatrogenic or traumatic benign distal oesophageal perforation.
Intervention:
Primary repair with reinforcement using pleura, pericardial flap, or gastric fundus. Of the 3 patients with achalasia, 2 had oesophagomyotomy alone and 1 had oesophagomyotomy with fundoplication. Associated distal obstruction caused by reflux stricture was treated by dilatation and fundoplication in 1 patient.
Main Outcome Measures:
The causes of perforation, presence of underlying oesophageal disease, time to operation, postoperative leakage, mortality, and follow-up.
Results:
Perforation was caused by instrumentation in 10 patients, trauma in 3, and ingested foreign bodies in 2. 6 patients had pre-existing oesophageal diseases: achalasia in 3, hiatus hernia in 2, and reflux stricture in 1. 10 patients presented within 12 hours, and 5 patients more than 12 hours after the perforation. 4 postoperative leaks developed. One patient perforated a stress gastric ulcer and then developed pneumonia and died of multiple organ failure. At follow-up, all 14 surviving patients were able to eat a normal diet. 2 patients who had gastric fundus used as a reinforcement tissue developed mild gastro-oesophageal reflux and oesophagitis. Both responded to medical treatment.
Conclusion:
Primary repair and tissue reinforcement of benign distal oesophageal perforation is safe in early cases and obviates the need for a second operation.
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