The European journal of surgery = Acta chirurgica · 2000
Reinforced primary repair of early distal oesophageal perforation.
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Ayed A K, Al-Din H J, Asfar S K
Аннотация
OBJECTIVE: To describe our surgical technique for, and results of, reinforced primary repair in benign distal oesophageal perforation in early cases.
DESIGN: Retrospective study.
SETTING: Tertiary care hospital, Kuwait.
PATIENTS: 15 patients with iatrogenic or traumatic benign distal oesophageal perforation.
INTERVENTION: Primary repair with reinforcement using pleura, pericardial flap, or gastric fundus. Of the 3 patients with achalasia, 2 had oesophagomyotomy alone and 1 had oesophagomyotomy with fundoplication. Associated distal obstruction caused by reflux stricture was treated by dilatation and fundoplication in 1 patient.
MAIN OUTCOME MEASURES: The causes of perforation, presence of underlying oesophageal disease, time to operation, postoperative leakage, mortality, and follow-up.
RESULTS: Perforation was caused by instrumentation in 10 patients, trauma in 3, and ingested foreign bodies in 2. 6 patients had pre-existing oesophageal diseases: achalasia in 3, hiatus hernia in 2, and reflux stricture in 1. 10 patients presented within 12 hours, and 5 patients more than 12 hours after the perforation. 4 postoperative leaks developed. One patient perforated a stress gastric ulcer and then developed pneumonia and died of multiple organ failure. At follow-up, all 14 surviving patients were able to eat a normal diet. 2 patients who had gastric fundus used as a reinforcement tissue developed mild gastro-oesophageal reflux and oesophagitis. Both responded to medical treatment.
CONCLUSION: Primary repair and tissue reinforcement of benign distal oesophageal perforation is safe in early cases and obviates the need for a second operation.
DESIGN: Retrospective study.
SETTING: Tertiary care hospital, Kuwait.
PATIENTS: 15 patients with iatrogenic or traumatic benign distal oesophageal perforation.
INTERVENTION: Primary repair with reinforcement using pleura, pericardial flap, or gastric fundus. Of the 3 patients with achalasia, 2 had oesophagomyotomy alone and 1 had oesophagomyotomy with fundoplication. Associated distal obstruction caused by reflux stricture was treated by dilatation and fundoplication in 1 patient.
MAIN OUTCOME MEASURES: The causes of perforation, presence of underlying oesophageal disease, time to operation, postoperative leakage, mortality, and follow-up.
RESULTS: Perforation was caused by instrumentation in 10 patients, trauma in 3, and ingested foreign bodies in 2. 6 patients had pre-existing oesophageal diseases: achalasia in 3, hiatus hernia in 2, and reflux stricture in 1. 10 patients presented within 12 hours, and 5 patients more than 12 hours after the perforation. 4 postoperative leaks developed. One patient perforated a stress gastric ulcer and then developed pneumonia and died of multiple organ failure. At follow-up, all 14 surviving patients were able to eat a normal diet. 2 patients who had gastric fundus used as a reinforcement tissue developed mild gastro-oesophageal reflux and oesophagitis. Both responded to medical treatment.
CONCLUSION: Primary repair and tissue reinforcement of benign distal oesophageal perforation is safe in early cases and obviates the need for a second operation.