Evaluation of urgent esophagectomy in esophageal perforation

Background

Esophageal trauma is considered one of the most severe lesions of the digestivetract. There is still much controversy in choosing the best treatment for cases ofesophageal perforation since that decision involves many variables. The readinessof medical care, the patient''s clinical status, the local conditions of theperforated segment, and the severity of the associated injuries must be consideredfor the most adequate therapeutic choice.

Aim

To demonstrate and to analyze the results of urgent esophagectomy in a series ofpatients with esophageal perforation.

Methods

A retrospective study of 31 patients with confirmed esophageal perforation. Mostinjuries were due to endoscopic dilatation of benign esophageal disorders, whichhad evolved with stenosis. The diagnosis of perforation was based on clinicalparameters, laboratory tests, and endoscopic images. ‪The main surgical techniqueused was transmediastinal esophagectomy followed by reconstruction of thedigestive tract in a second surgical procedure. Patients were evaluated for thedevelopment of systemic and local complications, especially for the dehiscence orstricture of the anastomosis of the cervical esophagus with either the stomach orthe transposed colon.

Results

Early postoperative evaluation showed a survival rate of 77.1% in relation to theproposed surgery, and 45% of these patients presented no further complications.The other patients had one or more complications, being pulmonary infection andanastomotic fistula the most frequent. The seven patients (22.9%) who underwentesophageal resection 48 hours after the diagnosis died of sepsis. At medium andlong-term assessments, most patients reported a good quality of life and fullsatisfaction regarding the surgery outcomes.

Conclusions

Despite the morbidity, emergency esophagectomy has its validity, especially inwell indicated cases of esophageal perforation subsequent to endoscopic dilationfor benign strictures.