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Open Access Research article

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

Michael Hermansson1*, Jan Johansson2, Tomas Gudbjartsson3, Göran Hambreus2, Per Jönsson2, Ramon Lillo-Gil2, Ulrika Smedh1 and Thomas Zilling4

Author Affiliations

1 Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden

2 Department of General Surgery and Department of Thoracic Surgery, Lund University Hospital, Sweden

3 Department of Cardiothoracic Surgery, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland

4 Department of Surgery, Varberg Hospital, Varberg, Sweden

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BMC Surgery 2010, 10:31  doi:10.1186/1471-2482-10-31

Published: 28 October 2010

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.