Is it reasonable to set a time limit for stitching the esophageal perforation?

To evaluate the results of surgical therapy of esophageal perforation in relation to the time of onset.

A retrospective study of patients records with a discharge diagnose of esophageal perforation

During 12 years, 9 patients with esophageal perforation were treated at our surgical clinic. In 3 cases, the affected part of esophagus was in the neck, in 5 cases in the thorax and in one case in the abdomen. In 5 cases, the perforation was causally related to the foreign particle, in 3 cases it was spontaneous and in one case it developed after an insertion of the Sengstaken tube. All patients were indicated to the surgical therapy. In 7 patients, the perforation was stitched, in one patient, drainage of pleural cavity was performed and in one patient, a derivation above the perforation was done. The lethality was 3/9, in 2 cases with the thoracic part and in one case with the abdominal part of esophagus. In 3 patients, the stitching was healed despite the perforation was present longer then 24 hours.

Despite the data from literature and standards recommendations, the stitched esophageal perforation has healed after being present longer then 24 hours in 3 from 4 patients. On contrary, in early surgical therapy in 3 patients, 2 had died. The requirement for a time limit in surgical therapy of esophageal perforation is questionable. The lethality round 30 % persists (Tab. 8, Ref. 11). Full Text (Free, PDF) www.bmj.sk.