Late results of primary esophageal repair for spontaneous rupture of the esophagus (Boerhaave's syndrome).

Surgical management of Boerhaave's syndrome remains controversial. If left untreated, this is often a fatal condition. This was a retrospective review of cases operated on by one surgeon between 1981 and 1997. Eleven patients (8 males and 3 females), mean age of 63 years (range, 49-74 years), with Boerhaave's syndrome were treated surgically. A history of vomiting (10/11) and/or chest pain (11/11) was elicited in most cases, but only 3 of 11 cases were diagnosed correctly at presentation. From the onset of symptoms to diagnosis, the median delay was 30 hours (range, 6-1440 hours), and in 8 of 11 cases, the diagnosis was made >24 hours after the onset of symptoms. In all 11 cases, site of rupture was the lower one-third of the esophagus (9 to the left pleural cavity and 2 to the right pleural cavity). All cases were treated surgically after active initial resuscitation. The repair was further augmented by either a diaphragmatic flap (n = 1), bovine pericardial patch (n = 2), or Grillo pleural wrap (n = 8). A feeding jejunostomy was used in every case. Although the mean postoperative intensive care unit stay was only 1.8 days, the mean hospital stay was 37.5 days (range, 15-70 days). There were two hospital deaths (18%). After a mean follow-up of 12.5 years (range, 5-20 years), 7 of 11 patients (63%) are alive and asymptomatic. There was one death that was unrelated to the esophageal surgery. Only one patient reported dysphagia to solid food 5 years following primary esophageal repair. Prompt diagnosis and aggressive surgical management has acceptable in-hospital mortality. This condition is associated with significant morbidity, but the long-term outlook for the survivors is very favorable.