Operative treatment of non-malignant esophageal perforations - a summary of our experiences

Abstract

Despite significant development in surgical and intensive therapy, esophageal perforation is still a severe, life-threatening condition. Successful therapy depends on several clinical factors, available medical equipments, but most of all on the available expertise and experience. We retrospectively evaluated patients' data operated at the 1st Department of Surgery at Semmelweis University between 2005 and 2017 due to esophageal perforation of non-malignant origin. During the period above 77 patients were treated. All of them were referred to us from an external institute. 15 patients (19%) arrived in shock. The patients developed perforation in 29 cases spontaneously (38%), in 32 cases (41%) during endoscopy, in 12 cases (16%) due to food bolus impaction, and in 4 cases (5%) following balloon tamponade of esophageal variceal bleeding. Patients were sent to our clinic 2.7 days after the presentation of the symptoms. In 2 patients (2%) drainage, in 6 patients (8%) suture, in 8 patients (12%) funduplication, in 19 patients (28%) esophageal exclusion, and in 33 patients (50%) total esophageal extirpation had to be done. 27 patients (35%) died. Discussion, conclusion: Surgical treatment of esophageal injuries is basically influenced by two factors: observation time before surgery and the presence of sepsis symptoms. We have to perform radical surgery basically due to delay. Waste of time is caused by the non-uniform diagnostic strategy and the delay in the true diagnosis.