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Eur J Cardiothorac Surg 2005;27:356
© 2005 Elsevier Science NL

Letter to the Editor

Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment

Andrew D. Muir, Alastair Graham*

Department Of Cardiothoracic Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, North Ireland BT12 6BA, UK

Received 9 September 2004; accepted 25 October 2004.

* Corresponding author. Tel.: +44-2890 240503; fax: +44-2890 314159. (E-mail: andrewduncanmuir{at}hotmail.com).

Key Words: Oesophageal perforation • Boerhaave's syndrome

We read with interest the article by Jougon and colleagues [1] concerning primary repair for Boerhaave's Syndrome and were surprised that they did not include our recently published series of oesophageal perforations [2] in their literature review.

The authors have looked at 2 forms of operative repair of the oesophagus, namely exclusion and primary repair. We showed that multiple treatment options exist for the perforated oesophagus, ranging from conservative measures, primary repair, surgical drainage, through to formal resection of the oesophagus with none being clearly superior. Jougon et al discuss the influence of "delay to surgical intervention," but make no distinction between time from perforation to diagnosis, and time from diagnosis to surgical intervention. We found that the time from perforation to diagnosis had a predictive effect upon outcome of both univariate and multivariate analysis, however the time from diagnosis to operation or intervention did not independently predict outcome. This is an important point as once the diagnosis is made, the resuscitative measures of nil oral intake, intravenous fluids, broad spectrum antibiotic therapy, nasogastric suction and chest drainage are instituted, then rushing to theatre (often in the middle of the night) is not necessary. Instead surgical intervention can be planned in the appropriate institution on an elective operating list when the right expertise and facilities are available.

Oesophageal perforation is a rare condition that continues to cause significant morbidity and may be fatal. We believe that the cornerstones of a successful outcome are prompt recognition of the diagnosis, aggressive resuscitation and institution of conservative measures, then a patient specific treatment option based upon the patient's underlying diagnosis, physiological condition and past medical history.

References

  1. Jougon J, Mc Bride T, Delcambre F, Minniti A, Velly J-F. Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment. Eur J Cardiothorac Surg 2004;25:475-479.[Abstract/Free Full Text]
  2. Muir AD, White J, McGuigan JA, McManus KG, Graham AN. Treatment and outcomes of oesophageal perforation in a tertiary referral centre. Eur J Cardiothorac Surg 2003;23:799-804.[Abstract/Free Full Text]




This Article
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Alastair Graham
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