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(Chest. 1997;112:1304-1309.)
© 1997 American College of Chest Physicians

Multimodality Treatment of Esophageal Disruptions

Lajos Kotsis MD, PhD1; Szilárd Kostic MD1; and Kornélia Zubovits MD1

1 From the Postgraduate Medical University, Thoracic Surgical Clinic, Budapest, Hungary

The treatment of esophageal disruptions has changed since 1981. The value of a more selective assessment in six spontaneous ruptures and 30 mostly intrathoracic (83.4%) esophageal perforations is evaluated in this study. Based on the previous state of the esophagus, the time factor, and type and site of the disruption, reinforced primary repair (by diaphragmatic, muscular, pleural flap, or fundoplication), transhiatal closure, resection, intubation, suture combined with myotomy and fundoplication, esophageal diversion, and transhiatal mediastinal drainage were employed. The overall 30-day hospital mortality was 19.4%. Although these operations were mostly used in late (24 h to 7 months) perforations and ruptures, none of the patients with reinforced repair by autogenous diaphragmatic, muscular, or pleural flaps or fundoplication had fatal outcome for breakdown of the closure. Only patients with renal, cardiac, or multiorgan failure as a consequence of sepsis due to time elapsed before hospital admission died. The key to improve the prognosis of this life-threatening emergency is the more appropriate selection of the primary employed procedure.

Key Words: esophageal disruptions • importance of the primary employed procedure • multimodality management

Submitted on August 2, 1996
Accepted on March 29, 1997




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