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Esophageal perforation in South of Sweden: Results of surgical treatment in 125 consecutive patients

Hermansson, Michael; Johansson, Jan LU ; Gudbjartsson, Tomas; Hambreus, Göran; Jönsson, Per LU ; Lillo-Gil, Ramon; Smedh, Ulrika and Zilling, Thomas (2010) In BMC Surgery 10.
Abstract
Background: For many years there has been a debate as to which is the method of choice in treating patients with esophageal perforation. The literature consists mainly of small case series. Strategies for aiding patients struck with this disease is changing as new and less traumatic treatment options are developing. We studied a relatively large consecutive material of esophageal perforations in an effort to evaluate prognostic factors, diagnostic efforts and treatment strategy in these patients. Methods: 125 consecutive patients treated at the University Hospital of Lund from 1970 to 2006 were studied retrospectively. Prognostic factors were evaluated using the Cox proportional hazards model. Results: Pre-operative ASA score was the only... (More)
Background: For many years there has been a debate as to which is the method of choice in treating patients with esophageal perforation. The literature consists mainly of small case series. Strategies for aiding patients struck with this disease is changing as new and less traumatic treatment options are developing. We studied a relatively large consecutive material of esophageal perforations in an effort to evaluate prognostic factors, diagnostic efforts and treatment strategy in these patients. Methods: 125 consecutive patients treated at the University Hospital of Lund from 1970 to 2006 were studied retrospectively. Prognostic factors were evaluated using the Cox proportional hazards model. Results: Pre-operative ASA score was the only factor that significantly influenced outcome. Neck incision for cervical perforation (n = 8) and treatment with a covered stent with or without open drainage for a thoracic perforation (n = 6) had the lowest mortality. Esophageal resection (n = 8) had the highest mortality. A CAT scan or an oesophageal X-ray with oral contrast were the most efficient diagnostic tools. The preferred treatment strategy changed over the course of the study period, from a more aggressive surgical approach towards using covered stents to seal the perforation. Conclusion: Pre-operative ASA score was the only factor that significantly influenced outcome in this study. Treatment strategies are changing as less traumatic options have become available. Sealing an esophageal perforation with a covered stent, in combination with open or closed drainage when necessary, is a promising treatment strategy. (Less)
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author
organization
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type
Contribution to journal
publication status
published
subject
in
BMC Surgery
volume
10
publisher
BioMed Central
external identifiers
  • wos:000296433400001
  • scopus:77958573402
ISSN
1471-2482
DOI
10.1186/1471-2482-10-31
language
English
LU publication?
yes
id
4ad8aaf4-de9c-45cd-9041-f38539a41f6e (old id 2227406)
date added to LUP
2012-01-02 07:54:32
date last changed
2018-05-29 11:19:49
@article{4ad8aaf4-de9c-45cd-9041-f38539a41f6e,
  abstract     = {Background: For many years there has been a debate as to which is the method of choice in treating patients with esophageal perforation. The literature consists mainly of small case series. Strategies for aiding patients struck with this disease is changing as new and less traumatic treatment options are developing. We studied a relatively large consecutive material of esophageal perforations in an effort to evaluate prognostic factors, diagnostic efforts and treatment strategy in these patients. Methods: 125 consecutive patients treated at the University Hospital of Lund from 1970 to 2006 were studied retrospectively. Prognostic factors were evaluated using the Cox proportional hazards model. Results: Pre-operative ASA score was the only factor that significantly influenced outcome. Neck incision for cervical perforation (n = 8) and treatment with a covered stent with or without open drainage for a thoracic perforation (n = 6) had the lowest mortality. Esophageal resection (n = 8) had the highest mortality. A CAT scan or an oesophageal X-ray with oral contrast were the most efficient diagnostic tools. The preferred treatment strategy changed over the course of the study period, from a more aggressive surgical approach towards using covered stents to seal the perforation. Conclusion: Pre-operative ASA score was the only factor that significantly influenced outcome in this study. Treatment strategies are changing as less traumatic options have become available. Sealing an esophageal perforation with a covered stent, in combination with open or closed drainage when necessary, is a promising treatment strategy.},
  author       = {Hermansson, Michael and Johansson, Jan and Gudbjartsson, Tomas and Hambreus, Göran and Jönsson, Per and Lillo-Gil, Ramon and Smedh, Ulrika and Zilling, Thomas},
  issn         = {1471-2482},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {BMC Surgery},
  title        = {Esophageal perforation in South of Sweden: Results of surgical treatment in 125 consecutive patients},
  url          = {http://dx.doi.org/10.1186/1471-2482-10-31},
  volume       = {10},
  year         = {2010},
}