Oesophageal Perforation Surgical Treatment: What Affects the Outcome? A Multicenter Experience

Abstract

Background: Oesophageal perforation (OP) is a life-threatening condition requiring prompt diagnosis and treatment. Mortality is influenced by several factors, such as aetiology, defect location, comorbidities, age, and delays in treatment. This study reviews patients with OP undergoing surgery, analysing mortality risks and the impact of timing on surgical outcomes. Methods: Medical records of 45 patients surgically treated for OP across three tertiary centers were analysed. Results: Of the 45 patients, 31 were male (68.88%) and 14 were female (31.11%), with a mean age of 66.00 ± 17.75 years. Pre-operative CT was performed in all patients, and 18 (40%) underwent oesophagogastroduodenoscopy. As many as 25 patients (55.55%) presented within 24 h, 10 (22.22%) within 24-72 h, and 10 (22.22%) after 72 h. Symptoms included pain, vomiting, fever, dysphagia, and subcutaneous emphysema. Foreign body ingestion and Boerhaave's syndrome were the leading causes (33.33% each), followed by caustic ingestion (17.77%) and iatrogenic and traumatic cases. Treatments included primary repair, debridement, oesophagectomy, and oesophagogastrectomy. Primary repair was performed in 22 cases (48.88%), and muscle flaps reinforced 11 of these. Direct repair showed the highest success rate when performed within 24 h. Thirty patients (66.66%) experienced complications, including respiratory failure, oesophagopleural fistula, and sub-stenosis. The hospital stay average was 36.34 ± 35.03 days. Nine patients underwent same-session/two-stage gastroplasty or retrosternal coloplasty for reconstruction, with complications including stenosis and leaks. Six patients (13.33%) died within the first 24 h after surgery, primarily due to severe comorbidities (three (50%) were octogenarians). Conclusions: OP is a life-threatening condition with high mortality. Primary repair is the preferred treatment. Oesophagectomy and gastrectomy are reserved for extensive lesions. Muscle flaps can reinforce sutures in cervical and thoracic perforations. Mortality is mainly influenced by the severity of the patient's clinical picture and comorbidities, rather than by time and type of treatment.

Keywords: mediastinitis; oesophageal perforation; oesophagectomy; surgical emergency.

Figure 1

(A) Cervical X-Ray showing FB (chicken bone). (B) Cervical CT scan showing FB, hyperdense body. (C) CT cervical scan showing rectilinear body.

Figure 2

CT scan showing oesophageal perforation after ingestion of FB.

Figure 3

EGDS, showing oesophagus after caustic ingestion of a battery.

Figure 4

Foreign body removal after direct repair.

Figure 5

Oesophageal perforation for FB ingestion—dental prosthesis removed from oesophagus.

Figure 6

Isolation of the oesophagus and identification of oesophageal rupture.

Figure 7

Direct repair of oesophageal rupture with Vicryl 4/0 and muscular plane with Vicryl 3/0.

Figure 8

Pedicle flap prepared to be placed on oesophageal thoracic rupture as reinforcement.

Figure 9

Oesophagogastrectomy after caustic ingestion.

Figure 10

Coloplasty second stage recanalization surgery.

Figure 11

Removal foreign body in thoracotomy.

Figure 12

Oesophagectomy after caustic ingestion.

Figure 13

Cervical oesophageal preparation for bipolar exclusion.