Treatment of esophageal perforation in a referral center in taiwan

Yin-Kai Chao, Yun-Hen Liu, Po-Jen Ko, Yi-Cheng Wu, Ming-Ju Hsieh, Hui-Ping Liu, Pyng Jing Lin
Surgery Today 2005, 35 (10): 828-32

PURPOSE: The high mortality associated with esophageal perforation can be reduced by aggressive surgery and good critical care. We report our experience of treating esophageal perforation in a clinic in Taiwan.

METHODS: The subjects were 28 patients who underwent surgery for a benign esophageal perforation.

RESULTS: The esophageal perforation was iatrogenic in 11 patients, spontaneous in 8, and caused by foreign body injury in 9. Most (22/28) of the patients were seen longer than 24 h after perforation, and 77% had empyema preoperatively. The perforation was located in the cervical area in 5 patients and in the thoracic esophagus in 23. We performed primary repair in 24 patients, esophagectomy in 3, and drainage in 1. Leakage occurred after primary repair in ten (41%) patients, resulting in one death, and two patients died of other diseases. Postoperative leakage prolonged the hospital stay but had no impact on mortality. Overall survival was 90%. Univariate analysis revealed that age, timing of treatment, and cause and location of the perforation influenced outcome, but multivariate analysis failed to identify a predictor of mortality.

CONCLUSIONS: Early diagnosis and intervention are crucial to prevent morbidity and mortality in patients with esophageal perforation. Primary repair is feasible even if the diagnosis is delayed.

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