Esophageal repair following late diagnosis of intrathoracic perforation.

Multiple techniques, often complex, have been used to repair the esophagus following spontaneous, instrumental, or postsurgical perforation, especially when the diagnosis of perforation has been delayed. We have closed such perforations by wrapping a pedicled pleural flap around the esophagus, suturing it firmly over the area of leakage and around its margins. Due to inflammatory changes secondary to perforation, the flap is thickened and easily applied. Four patients were treated with this technique with success in every case. One patient with achalasia had sustained perforation three days prior to repair, another 30 hours following leakage at an esophageal suture line, the third 20 hours following esophagoscopic extraction of a necrosing foreign body, and the fourth 8 hours following hydrostatic bougienage for achalasia.