Multidisciplinary, minimally invasive approach for oesophageal perforations with delayed presentation

Area of Science:

• Thoracic surgery
• Gastroenterology
• Minimally invasive procedures

Background:

• Delayed presentation of esophageal perforation poses significant treatment challenges.
• Traditional management often involves extensive surgery and higher morbidity.
• A need exists for effective, less invasive strategies for these complex cases.

Purpose of the Study:

• To evaluate the outcomes of a multidisciplinary, minimally invasive treatment for delayed esophageal perforation.
• To assess the feasibility and success rate of this approach in a tertiary care setting.

Main Methods:

• Retrospective analysis of prospectively maintained data.
• Inclusion of patients with esophageal perforation presenting >48 hours post-symptoms without obstruction.
• Treatment involved self-expanding metallic stent (SEMS) or endoscopic clip placement followed by video-assisted thoracoscopic surgery (VATS) debridement/decortication.

Main Results:

• 12 patients (median age 55) with delayed perforation were treated.
• 83.3% (10/12) had spontaneous perforation; median symptom duration was 8 days.
• Overall success rate was 83.3% (10/12), defined by healing without diversion and stent removal.

Conclusions:

• A multidisciplinary, minimally invasive approach is feasible for thoracic esophageal perforation with delayed presentation.
• This strategy demonstrates a high success rate, offering a viable alternative to traditional methods.