Boerhaave’s syndrome: Primary repair vs. esophageal resection—Case reports and meta-analysis of the literature |
| |
Authors: | Otto Kollmar MD Werner Lindemann MD Sven Richter MD Ingo Steffen MD Georg Pistorius MD Martin K Schilling MD |
| |
Institution: | (1) Department of General, Visceral, and Vascular Surgery, University of the Saarland, 66421 Homburg/Saar, Germany;(2) Department of General Visceral and Transplantation Surgery, Charité, Humboldt University, Berlin, Germany |
| |
Abstract: | Boerhaave’s syndrome is a life-threatening disease with a high mortality. With regard to the heterogeneity of treatment strategies,
no comparative studies exist and recommendations remain controversial. Seventeen cases of Boerhaave’s syndrome operated on
between 1989 and 2000 at our hospital were reviewed retrospectively to compare the time period between perforation and diagnosis,
and the morbidity and mortality among the different treatment options. In addition, we conducted a meta-analysis of the literature
including all series containing five or more patients and compared the findings with our own data. Our patients with a perforation
history of less than 12 hours showed significantly fewer signs of sepsis compared to patients with a history of more than
12 hours. In a comparison of patients with primary repair vs. patients treated with esophageal resection or an exclusion operation,
no differences were found. In the literature, patients with a long period of perforation (more than 24 hours) were treated
more often with an esophageal resection than patients with primary repair. In cases of Boerhaave’s syndrome, primary suturing
of the esophageal perforation should be reserved only for those patients presenting within 12 hours after perforation. In
all other cases, depending on the extent of the tissue damage, a two-stage esophageal resection with cervical esophagostomy
and gastrostomy is recommended as the safest treatment. |
| |
Keywords: | Boerhaave’ s syndrome spontaneous esophageal rupture operative treatment meta-analysis |
本文献已被 SpringerLink 等数据库收录! |
|