Boerhaave syndrome surgery

Boerhaave syndrome Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Boerhaave syndrome from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Boerhaave syndrome surgery On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Boerhaave syndrome surgery All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Boerhaave syndrome surgery
CDC on Boerhaave syndrome surgery
Boerhaave syndrome surgery in the news
Blogs on Boerhaave syndrome surgery
Directions to Hospitals Treating Boerhaave syndrome
Risk calculators and risk factors for Boerhaave syndrome surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2]

Surgery

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.

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.