| Autor: |
D’Journo, Xavier Benoit, Doddoli, Christophe, Avaro, Jean Philippe, Lienne, Pascal, Giovannini, Marc A., Giudicelli, Roger, Fuentes, Pierre A., Thomas, Pascal A. |
| Předmět: |
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| Zdroj: |
Annals of Thoracic Surgery; May2006, Vol. 81 Issue 5, p1858-1862, 5p |
| Abstrakt: |
Background: Long-term outcome of patients treated for a spontaneous esophageal rupture (Boerhaave’s syndrome) is seldom reported. Methods: From 1989 to 2004, 62 esophageal perforations were treated in a single institution. Eighteen patients presented with a spontaneous esophageal rupture. Among them, 15 could be treated with a transthoracic primary repair and constituted the material of the present study. A chart review was performed with special attention to survival, residual symptoms, and anatomic and motility disorders. Results: Three patients died postoperatively (20%). At last follow-up, 10 patients were alive and 2 had died from unrelated causes. At a median delay of 13 months (3 to 74), 7 patients accepted to undergo complementary investigations. None of them had any anatomic abnormality as checked by barium swallow. Six patients complained of mild symptoms from gastroesophageal reflux. Six patients (85%) presented with esophageal motility disorders on manometry and 4 (54%) had nocturne chronic reflux disease on pH monitoring. Two patients underwent endoscopic ultrasonography, of which one presented with a focal absence of one layer of the esophageal wall within the area of the suture. With time, no patient experienced recurrence, but one developed a cancer in the cervical esophagus. Conclusions: These results suggest that esophageal functional disorders are the rule after primary repair of a Boerhaave’s syndrome. Whether or not these findings are causal, coincidental, or related to the surgical treatment remains unclear. However, performance of routine postoperative explorations is strongly encouraged for a better understanding of this challenging condition. [Copyright &y& Elsevier] |
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