Surgical treatment of Boerhaave's syndrome: when, how and why?

Ten cases of Boerhaave's syndrome have been treated in this hospital from 1983-1998. Nine patients underwent surgery resulting in complete recovery in seven cases and two postoperative deaths. One was treated with a satisfactory outcome. Vomiting was considered to be the determinative factor for the illness in eight cases. The relationship between the rupture of the esophagus and vomiting and the mechanism of its occurrence based on anatomy and pathophysiology is discussed. It is believed that the most beneficial time to perform surgery is based on the general condition of the patient. The surgical procedure should consist of closure of the lacerated esophagus, a complete clearance of the fibrinous coating on the surface of the pleura, mobilization of a pedicled omentum pad and a gastrostomy. The chest should be entered from the side where the esophagus was lacerated or the X-ray examination showed hydrothorax or hydropneumothorax. The most important factor to guarantee a successful outcome for surgery is a complete clear off of the empyema and early expansion of the lung in addition to effective nutritional support.