Boerhaave syndrome surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
===Objectives of surgical management=== | |||
===Surgical techniques=== | |||
The following general principles are used to perform a repair of a perforation of the esophagus: | The following general principles are used to perform a repair of a perforation of the esophagus: | ||
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* The mucosa is closed with absorbable sutures and the muscularis layer is closed with nonabsorbable sutures. | * The mucosa is closed with absorbable sutures and the muscularis layer is closed with nonabsorbable sutures. | ||
=== Postoperative management | === Postoperative management === | ||
* Nutritional support until oral feedings can be initiated and sustained. | * Nutritional support until oral feedings can be initiated and sustained. | ||
* IV broad spectrum antibiotics typically for 7 to 10 days | * IV broad spectrum antibiotics typically for 7 to 10 days | ||
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* Drains remain in place until the patient is tolerating oral feedings and without evidence of a leak. | * Drains remain in place until the patient is tolerating oral feedings and without evidence of a leak. | ||
=== Endoscopy | === Endoscopy === | ||
Endoscopic treatment for an esophageal perforation should be considered in patients who are unlikely to tolerate surgery.<ref name="pmid23711276">{{cite journal |vauthors=Schweigert M, Beattie R, Solymosi N, Booth K, Dubecz A, Muir A, Moskorz K, Stadlhuber RJ, Ofner D, McGuigan J, Stein HJ |title=Endoscopic stent insertion versus primary operative management for spontaneous rupture of the esophagus (Boerhaave syndrome): an international study comparing the outcome |journal=Am Surg |volume=79 |issue=6 |pages=634–40 |year=2013 |pmid=23711276 |doi= |url=}}</ref> | Endoscopic treatment for an esophageal perforation should be considered in patients who are unlikely to tolerate surgery.<ref name="pmid23711276">{{cite journal |vauthors=Schweigert M, Beattie R, Solymosi N, Booth K, Dubecz A, Muir A, Moskorz K, Stadlhuber RJ, Ofner D, McGuigan J, Stein HJ |title=Endoscopic stent insertion versus primary operative management for spontaneous rupture of the esophagus (Boerhaave syndrome): an international study comparing the outcome |journal=Am Surg |volume=79 |issue=6 |pages=634–40 |year=2013 |pmid=23711276 |doi= |url=}}</ref> | ||
Revision as of 19:58, 5 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2] Feham Tariq, MD [3]
Overview
Most physicians advice surgical intervention if the diagnosis is made within the first 24 hours after perforation. This can include primary repair of the defect, resection of the defect, diversion, drainage of collections.
Surgery
Objectives of surgical management
Surgical techniques
The following general principles are used to perform a repair of a perforation of the esophagus:
- Devitalized tissue is debrided from the perforation.
- Longitudinal incision of the muscular layer and along the muscle fibers superior and inferior to the perforation to expose the entire extent of the mucosal injury.
- The mucosa is closed with absorbable sutures and the muscularis layer is closed with nonabsorbable sutures.
Postoperative management
- Nutritional support until oral feedings can be initiated and sustained.
- IV broad spectrum antibiotics typically for 7 to 10 days
- A contrast esophagram is done on postoperative day seven if the patient is stable.
- Drains remain in place until the patient is tolerating oral feedings and without evidence of a leak.
Endoscopy
Endoscopic treatment for an esophageal perforation should be considered in patients who are unlikely to tolerate surgery.[1]
References
- ↑ Schweigert M, Beattie R, Solymosi N, Booth K, Dubecz A, Muir A, Moskorz K, Stadlhuber RJ, Ofner D, McGuigan J, Stein HJ (2013). "Endoscopic stent insertion versus primary operative management for spontaneous rupture of the esophagus (Boerhaave syndrome): an international study comparing the outcome". Am Surg. 79 (6): 634–40. PMID 23711276.