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. 2021 Jun;13(6):3420-3425.
doi: 10.21037/jtd-20-2445.

Usefulness of lavage and drainage using video-assisted thoracoscopic surgery for Boerhaave's syndrome: a retrospective analysis

Tasuku Hanajima  1 , Yuichi Kataoka  1 , Tomonari Masuda  1 , Yasushi Asari  1
Affiliations

Usefulness of lavage and drainage using video-assisted thoracoscopic surgery for Boerhaave's syndrome: a retrospective analysis

Tasuku Hanajima et al. J Thorac Dis. 2021 Jun.

Abstract

Background: Boerhaave's syndrome has a high mortality rate due to respiratory failure, septic shock, and multiple organ failure. We had previously carried out primary repair with laparotomy and postoperative computed tomography-guided drainage for mediastinal abscess and empyema. However, this treatment prolonged mechanical ventilator days and length of intensive care unit stay. Therefore, we decided to carry out primary repair with laparotomy and add lavage and drainage using video-assisted thoracoscopic surgery.

Methods: From April 2004 to September 2018, 18 patients with Boerhaave's syndrome were treated; 6 patients treated conservatively were excluded. Thus, 12 patients who underwent surgical treatment were divided into the computed tomography-guided drainage group (D group) (6 patients) and the lavage and drainage using video-assisted thoracoscopic surgery group (VATS group) (6 patients), and the two groups were retrospectively compared.

Results: The VATS group had significantly longer operation time than the D group {359 [328, 387] vs. 220 [155, 235] min, P=0.004}, but the ventilator-free days (VFDs) were significantly extended {24 [21, 24] vs. 10 [0, 17] days, P=0.02}, and the length of intensive care unit stay was significantly shortened {14 [8, 14] vs. 35 [29, 55] days, P=0.01}.

Conclusions: Lavage and drainage using video-assisted thoracoscopic surgery is an effective surgical method for Boerhaave's syndrome.

Keywords: Boerhaave’s syndrome; laparotomy; spontaneous esophageal rupture; video-assisted thoracoscopic surgery (VATS).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-2445). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of patients. Six of the 18 patients were treated conservatively and were excluded from the analysis. Primary repair was performed with laparotomy in 12 patients. These patients were divided into two groups according to the drainage method for the mediastinal and thoracic cavities after laparotomy. CT-guided drainage was performed in 6 patients (D group). On the other hand, lavage and drainage were performed using VATS in 6 patients (VATS group). VATS, video-assisted thoracoscopic surgery.
See this image and copyright information in PMC

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