606. THE CHANGES OF THORACOSCOPIC OR LAPAROSCOPIC APPROACH FOR SPONTANEOUS ESOPHAGEAL RUPTURE IN JAPAN

Abstract

Abstract Background The surgical treatment for esophageal rupture includes various approaches such as thoracotomy, laparotomy, thoracoscopy, and laparoscopy. These approaches aim to: Suture the perforation site, sealing it with omentum. or esophageal resection and reconstruction. Cleanse and drain the mediastinum or thoracic cavity. Adding gastrostomy or intestinal as needed. Many reports showed the usefulness of minimally invasive surgeries. In this study, we added our cases and discussed the surgical techniques and outcomes. Method I searched for reported cases in PubMed and the Journal of Health Care and Society and supplemented them with my experimental cases for analysis. All reports published between 2001 and the end of 2022 were included in this study. Results From 2001 to 2022, there have been 15 reports (16 cases) of idiopathic esophageal rupture using arthroscopic techniques, including our cases, 14 cases in men and 3 cases in women. The ages of the patients ranged from 39 to 78 years (mean 61 years, median 61 years), and the rupture sites were the lower esophagus in 15 cases (88%) and the middle part in 2 cases (12%). The time from onset of symptoms to surgery ranged from 4 to 77 hours. The approach method was thoracoscopy in 7 cases (41%), laparoscopy in 8 cases (47%), and a combination of thoracoscopic and laparoscopy in 2 cases (12%). Complications of Clavien-Dindo classification IIIa or higher were observed in 3 patients (18%). There were two cases each of thoracoscopic and laparoscopic complications in which complications were observed. The time from arthroscopic surgery to discharge was 12-120 days (mean 36.7 days, median 30.5 days). For cases with a thoracoscopic approach, the period from surgery to discharge is 23-120 days (average 50.1 days, median 39 days), and for cases with a laparoscopic approach, the period from surgery to discharge is 12-82 days (average 30 days). days, median 21 days). Discussion Spontaneous esophageal rupture develops various disease patterns such as mediastinum limited type with mild symptoms and intrathoracic rupture type. There are various treatment approaches, including conservative therapy, endoscopic closure, and surgery. The laparoscopic approach seemed to reduce the length of hospital stays. Conclusion The surgical approach for spontaneous esophageal rupture has been changed from thoracotomy to laparoscopic surgery. The trans hiatal procedure will increase among laparoscopic surgery. Spontaneous esophageal rupture is a remarkably highly invasive disease, and we thought that a less invasive and simpler treatment would be desirable.