Primary esophageal repair for Boerhaave's syndrome

Background. Boerhaave's syndrome is the most sinister cause of esophageal p erforation. The mediastinal contamination with microorganisms, gastric acid , and digestive enzymes results in a mediastinitis that is often fatal if u ntreated. Methods. We present a series of 21 patients seen in our unit in the 10 year s 1987 to 1996. Esophageal repair was performed in 17 (81%) of them. After the resuscitation of the patient in the intensive care unit, our strategy i s primary esophageal repair with a single layer of interrupted absorbable s utures combined with mediastinal toilet, mediastinal drainage, and drainage gastrostomy. The majority of patients (12/21) were referred more than 24 h ours after perforation. Results. The mean age of the patients was 60 +/- 17 years. The mean stay in the intensive care unit was 1.6 +/- 1.8 days and the median hospital stay, 14 days. There were three deaths, an overall mortality rate of 14.3%. Conclusions. When combined with mediastinal toilet, mediastinal drainage, a nd drainage gastrostomy, primary esophageal repair for Boerhaave's syndrome gives an acceptable mortality and should not be resented for patients seen within 24 hours after spontaneous rupture. (Ann Thorac Surg 1999;67:818-20 ) (C) 1999 by The Society of Thoracic Surgeons.