[Esophageal perforation: which treatment under which situation?]

Six disruptions of the thoracic esophagus were treated in our unit between 1979 and 1995. Three were iatrogenic and three spontaneous. Five were operated upon, and one treated conservatively. Surgical repair consisted of reinforced sutures (in two), direct fistulae (in two), and exclusion-diversion (in one). One leak occurred 6 days after direct closure, which was treated in turn with success by a directed fistula. There was one death. The five patients who survived resumed normal oral feeding in eleven days. Directed fistulization using a small T-tube appeared as a safe option when it could be done within 24 hours. Exclusion coupled with diversion was successful in one case which appeared desperate at first.