Year 2020 / Volume 112 / Number 9
Original
Surgical management of Boerhaave’s syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients

669-674

DOI: 10.17235/reed.2020.6746/2019

Xiao-Liang Yan, Li Jing, Lin-Jing Guo, Yun-Kui Huo, Yong-Cai Zhang, Xiu-Wen Yan, Yong-Zhi Deng,

Abstract
Background: spontaneous esophageal rupture (Boerhaave’s syndrome) is a rare and challenging clinical condition. Objective: to evaluate the outcome of different surgical treatments for patients with Boerhaave’s syndrome with an early diagnosis (< 24 h) and delayed diagnosis (> 24 h), using a retrospective cohort study in a tertiary referral center. Patients and methods: eighty-eight patients with Boerhaave’s syndrome who underwent surgical treatment were identified from March 1994 to March 2019 in the First Hospital of Shanxi Medical University. Subsequently, they were retrospectively divided into two groups according to time from symptom onset to diagnosis (group 1, < 24 h, n = 16; group 2, > 24 h, n = 72). Primary suture repair was used in group 1 and reinforcement with a vascular muscle flap was used in group 2, in order to reduce the incidence of fistula. Patients in group 2 were further divided into two subgroups according to reinforcement using diaphragmatic flaps (subgroup 1) or intercostal muscle flaps (subgroup 2). Results: the duration of hospitalization and stay in Intensive Care Unit (ICU) was significantly shorter in group 1 (p = 0.027 and p = 0.001). Group 1 had fewer postoperative esophageal leaks (p = 0.037) compared to group 2. Various aspects were compared in the two subgroups and the differences were not statistically significant (p > 0.05). Conclusions: it is very important to establish an early diagnosis for patients with Boerhaave’s syndrome. Early (< 24 h) and primary suture repair is superior to delayed (> 24 h) primary repair, even for those reinforced with vascular muscle flaps. Furthermore, repair reinforcement with different muscle flaps appears to render similar results for patients with delayed diagnosis.
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References
1.Biancari F, Saarnio J, Mennander A, et al. Outcome of patients with esophageal perforations: a multicenter study. World J Surg 2014;38:902-9. DOI: 10.1007/s00268-013-2312-2
2.Khan AZ, Strauss D, Mason RC. Boerhaave syndrome: diagnosis and surgical management. Surgeon 2007;5:39-44.
3.Biancari F, D’Andrea V, Paone R, et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg 2013;37:1051-9. DOI: 10.1007/s00268-013-1951-7
4.Derbes VJ, Mitchell Jr RE. Hermann Boerhaave’s Atrocis, nec descripti prius, morbi historia, the first translation of the classic case report of rupture of the esophagus, with annotations. Bull Med Libr Assoc 1955;43:217-40.
5.Sulpice L, Dileon S, Rayar M, et al. Conservative surgical management of Boerhaave's syndrome: experience of two tertiary referral centers. Int J Surg 2013;11:64-7. DOI: 10.1016/j.ijsu.2012.11.013.
6.Teh E, Edwards J, Duffy J, et al. Boerhaave's syndrome: a review of management and outcome. Interact Cardiovasc Thorac Surg 2007;6:640-3. DOI: 10.1510/icvts.2007.151936
7.Brinster CJ, Singhal S, Lee L, et al. Evolving options in the management of esophageal perforation. Ann Thorac Surg 2004;77:1475-83. DOI: 10.1016/j.athoracsur.2003.08.037
8.Sdralis EIK, Petousis S, Rashid F, et al. Epidemiology, diagnosis, and management of esophageal perforations: systematic review. Dis Esophagus 2017;30:1-6. DOI: 10.1093/dote/dox013
9.Sudarshan M, Elharram M, Spicer J, et al. Management of esophageal perforation in the endoscopic era: Is operative repair still relevant? Surgery 2016;160:1104-10. DOI: 10.1016/j.surg.2016.07.025
10.de Schipper JP, Pull ter Gunne AF, Oostvogel HJ, et al. Spontaneous rupture of the oesophagus: Boerhaave's syndrome in 2008. Literature review and treatment algorithm. Dig Surg 2009;26:1-6. DOI: 10.1159/000191283. Epub 2009 Jan 15
11.Griffin SM, Lamb PJ, Shenfine J, et al. Spontaneous rupture of the oesophagus. Br J Surg 2008;95:1115-20. DOI: 10.1002/bjs.6294
12.Søreide JA, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the frst 24 hours. Scand J Trauma Resusc Emerg Med 2011;19:66. DOI: 10.1186/1757-7241-19-66
13.Valdivielso Cortázar E, Couto Wörner I, Alonso Aguirre P. Endoscopic management of Boerhaave’s síndrome. Rev Esp Enferm Dig 2019;111:493. DOI: 10.17235/reed.2019.6013/2018
14.Barrett NR. Report of a case of spontaneous perforation of the oesophagus successfully treated by operation. Br J Surg 1947;35:216-8. DOI: 10.1002/bjs.18003513821
15.Dasari BV, Neely D, Kennedy A, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg 2014;259:852-60. DOI: 10.1097/SLA.0000000000000564
16.Mackler SA. Spontaneous rupture of the esophagus; an experimental and clinical study. Surg Gynecol Obstet 1952;95:345-56.
17.Lázár G Jr, Paszt A, Simonka Z, et al. A successful strategy for surgical treatment of Boerhaave's syndrome. Surg Endosc 2011;25:3613-9. DOI: 10.1007/s00464-011-1767-1
18.Bayram AS, Erol MM, Melek H, et al. The success of surgery in the frst 24 hours in patients with esophageal perforation. Eurasian J Med 2015;47:41–7. DOI: 10.5152/eajm.2014.55
19.Han D, Huang Z, Xiang J, et al. The role of operation in the treatment of Boerhaave’s syndrome. Biomed Res Int 2018;2018:8483401. DOI: 10.1155/2018/8483401
20.Shen G, Chai Y, Zhang GF. Successful surgical strategy in a late case of Boerhaave's syndrome. World J Gastroenterol 2014;20:12696-700. DOI: 10.3748/wjg.v20.i35.12696
21.Pezzetta E, Kokudo T, Uldry E, et al. The surgical management of spontaneous esophageal perforation (Boerhaave's syndrome)-20 years of experience. Biosci Trends 2016;10:120-4. DOI: 10.5582/bst.2016.01009
22.Hauge T, Kleven OC, Johnson E, et al. Outcome after stenting and débridement for spontaneous esophageal rupture. Scand J Gastroenterol. 2018;53:398-402. DOI: 10.1080/00365521.2018.1448886
23.Glatz T, Marjanovic G, Kulemann B, et al. Management and outcome of esophageal stenting for spontaneous esophageal perforations. Dis Esophagus 2017;30:1-6. DOI: 10.1111/dote.12461
24.Fausto B, Tuomas T, Tatu Y, et al. Outcome of stent grafting for esophageal perforations: single-center experience. Surg Endosc 2017;31:3696-702. DOI: 10.1007/s00464-016-5408-6
25.Nakano T, Onodera K, Ihikawa H, et al. Thoracoscopic primary repair with mediastinal drainage is a viable option for patients with Boerhaave’s syndrome. J Thorac Dis 2018;10:784-9. DOI: 10.21037/jtd.2018.01.50
26.Okamoto H, Onodera K, Kamba R, et al. Treatment of spontaneous esophageal rupture (Boerhaave syndrome) using thoracoscopic surgery and sivelestat sodium hydrate. J Thorac Dis 2018;10:2206-12. DOI: 10.21037/jtd.2018.03.136
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Yan X, Jing L, Guo L, Huo Y, Zhang Y, Yan X, et all. Surgical management of Boerhaave’s syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients. 6746/2019


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Publication history

Received: 15/11/2019

Accepted: 01/02/2020

Online First: 04/06/2020

Published: 10/09/2020

Article revision time: 71 days

Article Online First time: 202 days

Article editing time: 300 days


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