The role of esophagectomy in the management of esophageal perforations

Áron Altorjay, J. Kiss, Attila Vörös, Endre Szirányi

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

Background. Despite the many advancements made in thoracic surgery, the management of patients with esophageal perforation remains problematic and controversial. Methods. Between 1985 and 1995, 27 esophagectomies were performed for perforation of the thoracic esophagus. A retrospective review of the records of these patients was carried out, and a scoring scale developed by Elebute and Stoner to grade the severity of sepsis was applied. Results. Among the 27 patients undergoing esophagectomy for a perforation, the interval between rupture and esophagectomy was less than 24 hours in only 11 patients (40.7%). Postoperative surgical complications occurred in 4 patients (14.8%) and nonsurgical complications, in 7 (25.9%). The hospital mortality rate was 3.7% (1/27). In 14 patients, primary reconstruction was performed in the bed of the excised esophagus. There were no anastomotic leaks in this subgroup. This suggests that an anastomosis between viable, well-vascularized tissues is more important for successful healing than avoidance of some degree of contamination of the adjacent mediastinum. On follow-up, which averages 41 months, 73% of patients (16/22) have neither symptoms nor complaints. Conclusions. Esophageal resection definitively eliminates the source of intrathoracic sepsis, the perforation, and the affected esophagus. Reconstruction carried out in one stage does not increase operative morbidity. Esophageal resection and reconstruction is a valid approach even in cases of spontaneous perforation in which the diagnosis is markedly delayed.

Original languageEnglish
Pages (from-to)1433-1436
Number of pages4
JournalAnnals of Thoracic Surgery
Volume65
Issue number5
DOIs
Publication statusPublished - May 1998

Fingerprint

Esophageal Perforation
Esophagectomy
Esophagus
Sepsis
Anastomotic Leak
Mediastinum
Hospital Mortality
Thoracic Surgery
Rupture
Thorax
Morbidity
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

The role of esophagectomy in the management of esophageal perforations. / Altorjay, Áron; Kiss, J.; Vörös, Attila; Szirányi, Endre.

In: Annals of Thoracic Surgery, Vol. 65, No. 5, 05.1998, p. 1433-1436.

Research output: Contribution to journalArticle

Altorjay, Áron ; Kiss, J. ; Vörös, Attila ; Szirányi, Endre. / The role of esophagectomy in the management of esophageal perforations. In: Annals of Thoracic Surgery. 1998 ; Vol. 65, No. 5. pp. 1433-1436.
@article{e976e76d33bc4808866fc63cceec0ea6,
title = "The role of esophagectomy in the management of esophageal perforations",
abstract = "Background. Despite the many advancements made in thoracic surgery, the management of patients with esophageal perforation remains problematic and controversial. Methods. Between 1985 and 1995, 27 esophagectomies were performed for perforation of the thoracic esophagus. A retrospective review of the records of these patients was carried out, and a scoring scale developed by Elebute and Stoner to grade the severity of sepsis was applied. Results. Among the 27 patients undergoing esophagectomy for a perforation, the interval between rupture and esophagectomy was less than 24 hours in only 11 patients (40.7{\%}). Postoperative surgical complications occurred in 4 patients (14.8{\%}) and nonsurgical complications, in 7 (25.9{\%}). The hospital mortality rate was 3.7{\%} (1/27). In 14 patients, primary reconstruction was performed in the bed of the excised esophagus. There were no anastomotic leaks in this subgroup. This suggests that an anastomosis between viable, well-vascularized tissues is more important for successful healing than avoidance of some degree of contamination of the adjacent mediastinum. On follow-up, which averages 41 months, 73{\%} of patients (16/22) have neither symptoms nor complaints. Conclusions. Esophageal resection definitively eliminates the source of intrathoracic sepsis, the perforation, and the affected esophagus. Reconstruction carried out in one stage does not increase operative morbidity. Esophageal resection and reconstruction is a valid approach even in cases of spontaneous perforation in which the diagnosis is markedly delayed.",
author = "{\'A}ron Altorjay and J. Kiss and Attila V{\"o}r{\"o}s and Endre Szir{\'a}nyi",
year = "1998",
month = "5",
doi = "10.1016/S0003-4975(98)00201-X",
language = "English",
volume = "65",
pages = "1433--1436",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - The role of esophagectomy in the management of esophageal perforations

AU - Altorjay, Áron

AU - Kiss, J.

AU - Vörös, Attila

AU - Szirányi, Endre

PY - 1998/5

Y1 - 1998/5

N2 - Background. Despite the many advancements made in thoracic surgery, the management of patients with esophageal perforation remains problematic and controversial. Methods. Between 1985 and 1995, 27 esophagectomies were performed for perforation of the thoracic esophagus. A retrospective review of the records of these patients was carried out, and a scoring scale developed by Elebute and Stoner to grade the severity of sepsis was applied. Results. Among the 27 patients undergoing esophagectomy for a perforation, the interval between rupture and esophagectomy was less than 24 hours in only 11 patients (40.7%). Postoperative surgical complications occurred in 4 patients (14.8%) and nonsurgical complications, in 7 (25.9%). The hospital mortality rate was 3.7% (1/27). In 14 patients, primary reconstruction was performed in the bed of the excised esophagus. There were no anastomotic leaks in this subgroup. This suggests that an anastomosis between viable, well-vascularized tissues is more important for successful healing than avoidance of some degree of contamination of the adjacent mediastinum. On follow-up, which averages 41 months, 73% of patients (16/22) have neither symptoms nor complaints. Conclusions. Esophageal resection definitively eliminates the source of intrathoracic sepsis, the perforation, and the affected esophagus. Reconstruction carried out in one stage does not increase operative morbidity. Esophageal resection and reconstruction is a valid approach even in cases of spontaneous perforation in which the diagnosis is markedly delayed.

AB - Background. Despite the many advancements made in thoracic surgery, the management of patients with esophageal perforation remains problematic and controversial. Methods. Between 1985 and 1995, 27 esophagectomies were performed for perforation of the thoracic esophagus. A retrospective review of the records of these patients was carried out, and a scoring scale developed by Elebute and Stoner to grade the severity of sepsis was applied. Results. Among the 27 patients undergoing esophagectomy for a perforation, the interval between rupture and esophagectomy was less than 24 hours in only 11 patients (40.7%). Postoperative surgical complications occurred in 4 patients (14.8%) and nonsurgical complications, in 7 (25.9%). The hospital mortality rate was 3.7% (1/27). In 14 patients, primary reconstruction was performed in the bed of the excised esophagus. There were no anastomotic leaks in this subgroup. This suggests that an anastomosis between viable, well-vascularized tissues is more important for successful healing than avoidance of some degree of contamination of the adjacent mediastinum. On follow-up, which averages 41 months, 73% of patients (16/22) have neither symptoms nor complaints. Conclusions. Esophageal resection definitively eliminates the source of intrathoracic sepsis, the perforation, and the affected esophagus. Reconstruction carried out in one stage does not increase operative morbidity. Esophageal resection and reconstruction is a valid approach even in cases of spontaneous perforation in which the diagnosis is markedly delayed.

UR - http://www.scopus.com/inward/record.url?scp=0032076032&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032076032&partnerID=8YFLogxK

U2 - 10.1016/S0003-4975(98)00201-X

DO - 10.1016/S0003-4975(98)00201-X

M3 - Article

VL - 65

SP - 1433

EP - 1436

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 5

ER -