C L Connelly1, P J Lamb, S Paterson-Brown. 1. The Royal Infirmary of Edinburgh, 72/3 Marchmont Road, Edinburgh EH9 1HS, UK. c.l.connelly@sms.ed.ac.uk.
Abstract
INTRODUCTION: Boerhaave's syndrome is associated with high mortality and morbidity. This study aimed to assess outcome following treatment in a specialist upper gastrointestinal surgical unit. METHODS: Patients were identified from a prospectively collected database (Lothian Surgical Audit) and their records reviewed. Primary outcomes were mortality and serious morbidity. Secondary outcomes included time to theatre, operation undertaken and length of hospital stay. RESULTS: Twenty patients with Boerhaave's syndrome were identified between 1997 and 2011. Four patients (20%) died in hospital. The mean time to theatre from symptom onset was 2.4 days. This was 7.3 days in the patients who died compared with 1.5 days in survivors. Five patients underwent primary repair of rupture, eleven underwent direct closure over a T-tube and one rupture was irreparable. Three patients were managed non-operatively and all survived. Outcomes were similar for the different surgical groups. There was one death following primary closure (20%) and two after T-tube drainage (18%). The mean length of hospital stay was 35.7 days after T-tube drainage and 20.5 days after primary repair. The 3 patients with small, self-contained leaks had a mean length of stay of 5.7 days. CONCLUSIONS: Aggressive surgical management with direct repair is associated with good survival in patients with Boerhaave's syndrome. Delayed time to theatre is associated with increased mortality. Patients with small, contained leaks without signs of sepsis can be managed non-operatively with a good outcome.
INTRODUCTION: Boerhaave's syndrome is associated with high mortality and morbidity. This study aimed to assess outcome following treatment in a specialist upper gastrointestinal surgical unit. METHODS: Patients were identified from a prospectively collected database (Lothian Surgical Audit) and their records reviewed. Primary outcomes were mortality and serious morbidity. Secondary outcomes included time to theatre, operation undertaken and length of hospital stay. RESULTS: Twenty patients with Boerhaave's syndrome were identified between 1997 and 2011. Four patients (20%) died in hospital. The mean time to theatre from symptom onset was 2.4 days. This was 7.3 days in the patients who died compared with 1.5 days in survivors. Five patients underwent primary repair of rupture, eleven underwent direct closure over a T-tube and one rupture was irreparable. Three patients were managed non-operatively and all survived. Outcomes were similar for the different surgical groups. There was one death following primary closure (20%) and two after T-tube drainage (18%). The mean length of hospital stay was 35.7 days after T-tube drainage and 20.5 days after primary repair. The 3 patients with small, self-contained leaks had a mean length of stay of 5.7 days. CONCLUSIONS: Aggressive surgical management with direct repair is associated with good survival in patients with Boerhaave's syndrome. Delayed time to theatre is associated with increased mortality. Patients with small, contained leaks without signs of sepsis can be managed non-operatively with a good outcome.
Authors: Clayton J Brinster; Sunil Singhal; Lawrence Lee; M Blair Marshall; Larry R Kaiser; John C Kucharczuk Journal: Ann Thorac Surg Date: 2004-04 Impact factor: 4.330
Authors: D Vallböhmer; A H Hölscher; M Hölscher; M Bludau; C Gutschow; D Stippel; E Bollschweiler; W Schröder Journal: Dis Esophagus Date: 2009-10-26 Impact factor: 3.429
Authors: Ali Ahmed Al-Zahir; Osama Habib AlSaif; Manal Mohammed AlNaimi; Sami Abdul Mohsin Almomen; Abdul-Wahed Nasir Meshikhes Journal: Am J Case Rep Date: 2019-06-10
Authors: Daniel N Velasco Hernández; Héctor R Horiuchi; Lucas A Rivaletto; Fidelio Farina; Matías Viscuso Journal: Ann Med Surg (Lond) Date: 2019-07-13
Authors: Liang-Liang Yu; Zheng-Fu He; Qi-Fang Liu; Ning Dai; Jian-Min Si; Bei Ye; Jian-Cang Zhou Journal: J Int Med Res Date: 2018-01-29 Impact factor: 1.671