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[Esophageal perforation--indications for surgical therapy]
T Junginger1, W Schäfer, T Böttger
1Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität, Mainz.
Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|November 1, 1991
Summary
Surgical repair of esophageal perforations, especially when performed early, presents a low risk. Conservative therapy for esophageal perforations carries significant, uncalculable risks and should be used cautiously.
Area of Science:
- Gastroenterology
- Thoracic Surgery
- Surgical Oncology
Background:
- Esophageal perforations are a critical condition requiring prompt management.
- Treatment outcomes depend heavily on the timing and approach to intervention.
Purpose of the Study:
- To evaluate the outcomes of surgical versus conservative management for esophageal perforations.
- To determine the risks associated with different treatment strategies for esophageal perforations.
Main Methods:
- Retrospective analysis of 32 patients with esophageal perforations treated between 1970 and 1990.
- Surgical interventions included bilateral closing suture, mucosal suture, extramyotomy with semifundoplication for achalasia, and subtotal esophagectomy with esophageal graft.
- Conservative therapy was administered to a separate patient group.
Main Results:
- The surgical group experienced a 21% postoperative mortality rate (4 out of 19 patients).
- The conservative therapy group had a significantly higher mortality rate, with 7 out of 13 patients lost.
- Mortality in the surgical group was not attributed to the intervention site.
Conclusions:
- Early surgical intervention for esophageal perforations is associated with a low risk.
- Conservative management of esophageal perforations poses an uncalculable risk and should be reserved for specific cases, such as minor perforations or patients with incurable cancer.