Repair of Distal Esophageal Perforation (Boerhaave's Syndrome) by Left Thoracoscopy with the Patient in Prone Position

Abstract

Abstract Introduction: Boerhaave's syndrome is an emergency disease related to high risk of mortality and morbidity.1 Surgical treatment is usually performed by thoracotomy or thoracoscopy with the patient in lateral position.2 The author reports a patient with a distal esophageal perforation repaired by left thoracoscopy in prone position. Materials and Methods: A 44-year-old man was admitted to emergency room after 14 hours of an episode of vomiting and hematemesis. Preoperative work-up evidenced a perforation of the distal esophagus on the left side, associated to a pneumomediastinum. The patient underwent left thoracoscopy in prone position, after induction of general anesthesia using the Carlens double-lumen tube. Three trocars (5, 10, and 5 mm) were placed in the 5th, 7th, and 10th intercostal spaces, respectively. The exploration of the chest cavity showed the presence of free liquid and fibrin, without evident esophageal perforation. The latter was, however, demonstrated after the dissection of th...