REINFORCED PRIMARY REPAIR OF THORACIC ESOPHAGEAL-PERFORATION

Background. Treatment of esophageal perforation, especially when diagn osed late, remains controversial. Methods. Twenty-eight patients were treated for thoracic esophageal perforation with reinforced primary re pair regardless of time of presentation. Results. Fifteen patients wer e treated early (<24 hours) with no deaths. Two had contained postoper ative leaks, which healed. Thirteen were treated late (mean, 5.5 days) with four deaths (3 with healed repairs). Postoperative leaks occurre d in 7 patients; of the leaks, 4 healed, 2 became a controlled fistula , and 1 required reoperation. Primary healing with preservation of the native esophagus was achieved in 25 patients (89%). Among the 18 pati ents without evidence of sepsis preoperatively, postoperative leaks de veloped in 2 (11%). Ten patients had evidence of sepsis preoperatively , and postoperative leaks developed in 7 (70%). Conclusions. Patients who present with sepsis have an increased risk of postoperative leak a nd therefore should have the repair buttressed. Overall mortality was 14% and no deaths were due to persistent leaks or mediastinal sepsis. Reinforced primary repair retains the native esophagus and avoids the need for later reconstructive operations. In the absence of a nondilat able stricture or cancer, reinforced primary repair should be performe d for most thoracic esophageal perforations, early or late.