Surgical treatment of esophageal perforation

In spite of the progress made during the last few decades, esophageal perforation continues to carry a serious prognosis. The aim of this study is to present our experience with surgical treatment of esophageal perforation.

Eight patients with esophageal perforation were submitted to surgical treatment with varying time intervals between the perforation and the operation. The surgical technique was individualized according to the location of the perforation and the severity of the local inflammatory and necrotic findings. Follow-up data was obtained by follow-up examination or telephone contact with the family doctors. The medical records were reviewed. The cause, the location and the clinical manifestations of perforation, the underlying esophageal disease, the imaging techniques and other examinations which were used to establish diagnosis, the time interval between the perforation and the operation, the surgical techniques, the outcome, the complications, the duration of postoperative hospitalization, and the late results were analyzed.

The perforation was due to iatrogenic injury in 6 of 8 patients. Underlying esophageal disease was present in 4 patients. The mean time interval between the perforation and the operation was 4.3 days. Primary repair was attempted in 5 patients, exclusion-diversion of the esophagus in 2 and thorough drainage in 1 patient. There was no mortality. Primary closure was achieved in 80% of the patients in whom primary repair was attempted. Seven out of 8 patients were alive 46-150 (mean, 99.12) months after the operation.

Surgery is the treatment of choice for patients with esophageal perforation including those seen more than 24 hours after the onset of symptoms. The chosen surgical technique depends on the location of perforation and the severity of local inflammatory and necrotic findings.