Multidisciplinary, minimally invasive approach for oesophageal perforations with delayed presentation.

Autor: Kumar A; Department of Thoracic Surgery, Institute of Chest Surgery and Chest Onco-Surgery, Medanta - The Medicity, Gurgaon, Haryana, India., Singla V; Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India., Pulle MV; Department of Thoracic Surgery, Institute of Chest Surgery and Chest Onco-Surgery, Medanta - The Medicity, Gurgaon, Haryana, India., Asaf BB; Department of Thoracic Surgery, Institute of Chest Surgery and Chest Onco-Surgery, Medanta - The Medicity, Gurgaon, Haryana, India., Puri HV; Department of Thoracic Surgery, Institute of Chest Surgery and Chest Onco-Surgery, Medanta - The Medicity, Gurgaon, Haryana, India., Bishnoi S; Department of Thoracic Surgery, Institute of Chest Surgery and Chest Onco-Surgery, Medanta - The Medicity, Gurgaon, Haryana, India.
Jazyk: angličtina
Zdroj: Journal of minimal access surgery [J Minim Access Surg] 2022 Jul-Sep; Vol. 18 (3), pp. 353-359.
DOI: 10.4103/jmas.JMAS_28_21
Abstrakt: Background: The present study aims to report the outcomes of a multidisciplinary, minimally invasive approach to treating patients with delayed presentation of oesophageal perforation.
Patients and Methods: The present study is a retrospective analysis of prospectively maintained data at a tertiary care centre. All patients with oesophageal perforation presenting over 48 h after the onset of symptoms and without oesophageal obstruction were included in the study. Self-expanding Metallic Stent (SEMS) or endoscopic clip placement was performed in all the patients, followed by video-assisted thoracoscopic surgery (VATS) debridement and decortication of pleural cavity collection. 'Success' was defined as, discharge without the need of oesophageal diversion and complete healing of leak site at 8 weeks with successful removal of the stent.
Results: Between March 2012 and December 2019, 12 patients (10 males, median age of 55 years- range of 39-71 years) with oesophageal perforation and delayed presentation underwent treatment with this approach. Ten patients had spontaneous perforation (83.3%) and one patient each had upper gastrointestinal endoscopy-induced and post-traumatic perforation. The median duration of symptoms was 8 days (range 3-31 days). SEMS was placed in ten patients and, in two patients, an over-the-scope clip was used. VATS decortication was done in ten patients (83.3%) and the remaining two (16.7%) underwent VATS debridement. One patient required oesophageal diversion and another patient expired due to sepsis. The overall success with this approach was 83.3%.
Conclusion: This multidisciplinary, minimally invasive approach is feasible in patients with thoracic oesophageal perforation and delayed presentation, with a high success rate.
Competing Interests: None
Databáze: MEDLINE
Externí odkaz: