Boerhaave's syndrome: A continuing challenge in thoracic surgery

Background/Aims: Boerhaave's syndrome accounts for 30-40% of esophageal dis ruption. The current literature regarding the management of these patients and problems in treatment remains controversial. Methodology: Between 1988 and 1998, 14 patients with Boerhaave's syndrome w ere treated in our unit. Five primary repairs and 9 esophagectomies were pe rformed. A retrospective review of these patients' records was carried out. The patients were divided into two groups. Group I: minor esophageal leak, local mediastinitis and hyperdynamic septic shock. All 5 cases were treate d by primary repair. Group II: moderate to severe esophageal leak, severe m ediastinitis and hypodynamic septic shock. All 9 cases were treated by tran sthoracic esophagectomy. Results: Group I: No postoperative mortality. The mean ICU stay was 4.6 day s. The mean hospitalization time was 14 days. Group II: The postoperative m ortality was 22.2%. The mean ICU stay was 28 days. The mean hospitalization time was 45 days. Conclusions. The choice of which operative approach should be made in patie nts, with Boerhaave's syndrome requires critical assessment of the patient' s overall status, the duration of leak and the extent of mediastinal and pl eural contamination.