Year 2020 / Volume 112 / Number 9
Original
Surgical management of Boerhaave’s syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients

669-674

DOI: 10.17235/reed.2020.6746/2019

Xiao-Liang Yan, Li Jing, Lin-Jing Guo, Yun-Kui Huo, Yong-Cai Zhang, Xiu-Wen Yan, Yong-Zhi Deng,

Abstract
Background: spontaneous esophageal rupture (Boerhaave’s syndrome) is a rare and challenging clinical condition. Objective: to evaluate the outcome of different surgical treatments for patients with Boerhaave’s syndrome with an early diagnosis (< 24 h) and delayed diagnosis (> 24 h), using a retrospective cohort study in a tertiary referral center. Patients and methods: eighty-eight patients with Boerhaave’s syndrome who underwent surgical treatment were identified from March 1994 to March 2019 in the First Hospital of Shanxi Medical University. Subsequently, they were retrospectively divided into two groups according to time from symptom onset to diagnosis (group 1, < 24 h, n = 16; group 2, > 24 h, n = 72). Primary suture repair was used in group 1 and reinforcement with a vascular muscle flap was used in group 2, in order to reduce the incidence of fistula. Patients in group 2 were further divided into two subgroups according to reinforcement using diaphragmatic flaps (subgroup 1) or intercostal muscle flaps (subgroup 2). Results: the duration of hospitalization and stay in Intensive Care Unit (ICU) was significantly shorter in group 1 (p = 0.027 and p = 0.001). Group 1 had fewer postoperative esophageal leaks (p = 0.037) compared to group 2. Various aspects were compared in the two subgroups and the differences were not statistically significant (p > 0.05). Conclusions: it is very important to establish an early diagnosis for patients with Boerhaave’s syndrome. Early (< 24 h) and primary suture repair is superior to delayed (> 24 h) primary repair, even for those reinforced with vascular muscle flaps. Furthermore, repair reinforcement with different muscle flaps appears to render similar results for patients with delayed diagnosis.
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Yan X, Jing L, Guo L, Huo Y, Zhang Y, Yan X, et all. Surgical management of Boerhaave’s syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients. 6746/2019


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Publication history

Received: 15/11/2019

Accepted: 01/02/2020

Online First: 04/06/2020

Published: 10/09/2020

Article revision time: 71 days

Article Online First time: 202 days

Article editing time: 300 days


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