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A successful strategy for surgical treatment of Boerhaave’s syndrome

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Abstract

Background

This retrospective single-institution study presents a successful treatment strategy for Boerhaave’s syndrome.

Methods

During 1995–2008, 15 patients with spontaneous esophageal perforation were treated. Patients were grouped according to time from symptoms to referral (early, <24 h; late, >24 h). In group I (early, n = 8 patients) treatment comprised primary surgical esophageal repair in seven cases and endoscopic clipping in one case. In group II (late, n = 7 patients) treatment comprised esophagectomy without primary reconstruction (4 cases) or controlled esophagocutaneous fistula (3 cases). Measures of outcome included age (years), delay to diagnosis (h), severe sepsis on admission, mortality, and hospital and intensive care unit (ICU) stay.

Results

The overall hospital mortality rate was 6.6% (1/15), being 0% (0/8) in group I and 14.2% (1/7) in group II. Patient age (49.6 vs. 68.6 years, P < 0.0001), delay to diagnosis (17.75 vs. 69 h, P < 0.0001), severe sepsis on admission (0 vs. 4, P = 0.0256), and ICU stay (4 vs. 14 days, P = 0.006) were all greater in group II.

Conclusions

Early diagnosis and carefully selected therapeutic tactics can reduce the mortality rate of Boerhaave’s syndrome to an acceptably low level. Methods of organ preservation and minimally invasive techniques can be applied successfully in the treatment.

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Disclosures

György Lázár, Attila Paszt, Zsolt Simonka, Anett Bársony, Szabolcs Ábrahám, and Gábor Horváth have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Albert Szent-Györgyi Medical Center, University of Szeged, Pécsi u. 6, Szeged, 6720, Hungary

    György Lázár Jr., Attila Paszt, Zsolt Simonka, Anett Bársony & Szabolcs Ábrahám

  2. Department of Anaesthesiology and Intensive Therapy, University of Szeged, Semmelweis u. 6, Szeged, 6720, Hungary

    Gábor Horváth

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  1. György Lázár Jr.
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  2. Attila Paszt
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  3. Zsolt Simonka
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Correspondence to György Lázár Jr..

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Lázár, G., Paszt, A., Simonka, Z. et al. A successful strategy for surgical treatment of Boerhaave’s syndrome. Surg Endosc 25, 3613–3619 (2011). https://doi.org/10.1007/s00464-011-1767-1

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