Boerhaave syndrome surgery: Difference between revisions
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===Objectives of surgical management=== | ===Objectives of surgical management=== | ||
The main objectives of surgical management in patients undergoing primary surgical management are as follows: | The main objectives of surgical management in patients undergoing primary surgical management are as follows: | ||
*Debridement of | *Debridement of devitalised oesophagus | ||
*Repair of perforation | *Repair of perforation | ||
*Drainage of pleural and mediastinal spaces | *Drainage of pleural and mediastinal spaces | ||
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===Surgical techniques=== | ===Surgical techniques=== | ||
The following | The following general principles are used to perform a repair of a perforation of the esophagus: | ||
* Devitalized tissue is debrided from the perforation. | * 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. | * 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. | ||
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=== 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> | ||
==References== | ==References== | ||
Revision as of 20:01, 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
The main objectives of surgical management in patients undergoing primary surgical management are as follows:
- Debridement of devitalised oesophagus
- Repair of perforation
- Drainage of pleural and mediastinal spaces
- Pleural and mediastinal decontamination
- Gastric decompression
- Enteral feeding access
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.